HYGIENE    OF 
THE     SCHOOLROOM 


BY 

WILLIAM  F.  BARRY,  M.  D., 

MEMBER     OF     THE     SCHOOL     BOARD,     CITY     OF     WOONSOCKET,     TL  I, 

VISITING    PHYSICIAN    TO  WOONSOCKET   HOSPITAL;    CONSULTING 

PHYSICIAN    TO   ST.  JOSEPH'S    HOSPITAL,      ROVIDENCE,    R.  I. 

MEMBER    OF  THE   AMERICAN    MEDICAL   ASSOCIATION. 


REVISED  EDITION 


SILVER,  BURDETT  AND    COMPANY 
NEW  YORK  BOSTON  CHICAGO 


COPYRIGHT,     1903,    BY 

SNOW    AND    FARNHAM 

COPYRIGHT,  1904,  1909,  igil,  BY 

SILVER,    BURDETT   AND    COMPANY 


"  What  will  it  profit  a  child  to  gain  the  whole 
2vorld  of  knowledge  and  lose  his  oivn  JicaltJi  ?  " 


254591 


PREFACE 


THE  aim  of  the  author  in  writing  this  book  is  to  place 
in  the  hands  of  educators  and  others  interested  in  child 
life  trustworthy  knowledge  of  the  means  of  conserving 
the  health  of  those  entrusted  to  their  care.  Compulsory 
education,  in  this  country,  is  almost  universal,  and  it 
should  be  the  duty  of  the  authorities  to  see  that  in  the 
schools  which  children  are  required  to  attend  nothing 
of  an  unhygienic  nature  exists.  It  is  the  truth,  however, 
that  until  very  recently  little  attention  was  given  to  the 
physical  side  of  the  child's  nature,  and  that  in  the  school- 
room the  fundamental  principles  of  hygiene  were  very 
little  understood — at  least  were  not  practised.  Some 
matters,  to  be  sure,  that  concern  the  pupil's  health,  such 
as  the  need  of  proper  diet,  of  proper  clothing,  and  of 
eye-glasses,  are  beyond  the  province  of  the  school  author- 
ities, and  can  be  reached  only  by  advice  to  parents  and 


vi  Preface. 

guardians.  But  many  of  the  evils  growing  out  of  a 
common  public  school  system  are  remediable :  there  can 
be,  for  example,  better  treatment  of  the  problems  of 
heating,  ventilating  and  lighting.  Upon  these  and  kin- 
dred topics  this  book  offers  suggestions  which  the  writer 
trusts  will  be  ol  value  to  whoever  is  interested  in  improv- 
ing the  physical  condition  of  the  children  in  our  schools. 
A  work  of  this  nature  is  essentially  for  teachers,  super- 
intendents and  school  governing  boards,  and  aims  in  all 
parts  to  be  practical  rather  than  to  quote  countless  pages 
of  statistics  usually  as  various  as  the  individual  opinions 
of  the  writers.  The  author  hopes  to  combine  the  con- 
sensus of  the  best  opinion  with  personal  knowledge  and 
investigation  and  make  clearer  the  much  discussed  sub- 
ject of  School  Hygiene. 


Preface  to  Second  Edition 


THE  encouraging  manner  in  which  the  first  edition  of 
"The  Hygiene  of  the  Schoolroom"  was  received  has  im- 
portance, principally,  m  showing  a  lively  interest  in  all 
that  tends  to  the  pupil's  physical  well  being. 

School  officials,  generally,  are  evincing  commendable 
concern  in  the  modern  construction  of  school  buildings, 
ventilation,  heating,  lighting,  school  diseases,  medical  in- 
spection and  kindred  subjects. 

In  many  cities  through  their  efforts  medical  super- 
vision has  been  adopted,  and,  its  benefits  being  so  ap- 
parent and  immediate,  it  has  always  found  lasting  favor. 

Teachers  have  appreciated  this  volume  as  a  reference 
book,  as  it  makes  their  duty  much  clearer  in  many  per- 
plexing points  of  a  scientific  nature,  which  they  must  de- 
cide upon,  yet  which  demand  almost  an  expert's  under- 
standing. 

As  promised  in  the  prospectus  at  the  beginning  of  the 
year,  the  book  was  to  be  a  practical  treatise  on  all  that 


viii  Preface  to  Third  Edition. 

pertains  to  the  health  of  the  pupil.  Upon  its  appear- 
ance it  was  eagerly  taken  up  by  educators  throughout 
the  country,  many  of  whom  have  expressed  their  grati- 
tude for  the  helpfulness  it  affords  in  the  field  it  -covers. 
Many,  too,  have  added  to  the  value  of  the  second  edition 
by  timely  suggestions  and  comment. 

It  is  hoped  that  this  book  will  help  to  keep  alive  the  in- 
terest that  is  being  felt  in  the  preservation  and  promotion 
of  the  pupil's  physical  welfare. 

The  author  trusts  that  it  will  be  received  with  the  same 
favor  and  appreciative  criticism  that  was  accorded  the 
first  edition. 

WOONSOCKET,  R.  I.,  Nov.  i,  1904. 


Preface  to  Third  Edition 

THE  author  is  glad  of  this  opportunity  to  offer  an  en- 
larged "  Hygiene  of  the  Schoolroom  "  in  the  third  edition. 

In  six  years  school  hygiene  has  taken  life  and  energy 
in  such  measure  as  has  been  accorded  no  other  depart- 
ment of  child  life  study.  If  this  work  has  been  helpful 
in  this  impetus,  the  author  counts  himself  well  repaid, 
and  if  one  child  has  been  spared  disease,  he  feels  that 
his  life  work  has  not  been  in  vain. 

WOONSOCKET,  R.  I.,  June  i,  1909. 


CONTENTS 


CHAPTER  I 

PAtiE 

THE  SELECTION  OF  A  SITE  FOR  A  SCHOOL  BUILDING        i 

CHAPTER  II 
THE  CONSTRUCTION  OF  SCHOOL  BUILDINGS    .  4 

CHAPTER  III 
VENTILATION          .          .          .          .          .          .17 

CHAPTER  IV 
HEATING          .......         30 

CHAPTER  V 
SCHOOL  FURNITURE       '   .          .          .          .          -35 

CHAPTER  VI 

LIGHT  .          .  57 

CHAPTER  VII 
THE  HYGIENE  OF  THE  EYE  ....        64 

CHAPTER  VIII 
THE  HYGIENE  OF  THE  EAR          ....        82 

CHAPTER  IX 
THE  VOCAL  ORGANS          .....        90 


x  Contents. 

CHAPTER  X 

PAGE 

RELATION  OF  CONTAGIOUS  DISEASES  TO  THE  SCHOOL    98 

CHAPTER  XI 

MEDICAL  INSPECTION  OF  SCHOOLS        .        .        .       126 

CHAPTER  XII 
MODERN  EDUCATION  AND  HEALTH         .        .        .141 

CHAPTER  XIII 
SCHOOL  DIET 157 

CHAPTER  XIV 
PHYSICAL  TRAINING  AND  EXERCISK  .        .       163 

CHAPTER  XV 
CORPORAL  PUNISHMENT 168 

CHAPTER  XVI 
SICKNESS  AND  ACCIDENT  IN  THE  SCHOOLROOM      .       175 

CHAPTER  XVII 
THE  TEACHER'S  HEALTH 182 

CHAPTER  XVIII. 
DEFECTIVE  CHILDREN  186 


LIST   OF   ILLUSTRATIONS. 


Page 

FIG.  i.  Standard  school  ward- 
robes in  a  school  hall 7 

FIG.  2.  A  window  ventilator 
made  of  glass 26 

FIG.  3.  Illustrates  a  desk  too 
high  for  a  child 36 

FIG.  4.  Illustrates  too  great 
space  between  the  seat  and 
desk 38 

FIG.  5.  Illustrates  a  very  com- 
mon fault  in  school  furniture  40 

FIG.  6.  Illustrates  a  too  small 
"  distance  "  between  the  seat 
and  desk 42 

FIG.  7.  Illustrates  a  desk  and 
chair  too  small  for  pupil's 
size 44 

FIG.  8.  Illustrates  ill-fitting  sta- 
tionary furniture 47 

FIG.  9.  Chair  and  desk  illus- 
trating proper  seating  of  pupil  52 

FIG.  10.  Shows  attention  paid 
to  light  in  schoolrooms  built 
twenty-five  years  ago 58 

FIG.  1 1 .  Shows  modern 
school  buildings  plentifully 
supplied  with  windows 60 


Page 

FIG.  12.  Diagram  of  the  eye- 
ball   69 

FIG.  13.  Shows  the  muscles  of 
the  eyeball  in  normal  posi- 
tion   72 

FIGS.  14,  15,  1 6.  Show  parallel 
rays  entering  the  eye 73 

FIG.  1 8.  Test  for  examining 
the  eyes  for  hypermetropia 
or  myopia 77 

FIG.  19.  Test  for  examining 
the  eyes  for  astigmatism. ...  78 

FIG.  22.  View  of  the  human 
ear 83 

FIG.  23.  Photograph  of  a  child 
suffering  from  adenoids  ....  88 

FIG.  24.  Photograph  of  a  child 
from  whose  throat  adenoid 
growths  have  been  removed-  89 

FIG.  25.  The  larynx  and  adja- 
cent parts,  as  seen  from 
above 91 

FIG.  26.  Sanitary  drinking 
fountain 116 

FIG.  27.  Sanitary  drinking 
fountain  in  use ..118 


DEFINITIONS 


Hygiene  is  the  branch  of  medical  science  which  con- 
cerns the  preservation  of  health. 

School  Hygiene  is  the  application  of  a  system  of  prin- 
ciples or  rules  designed  to  preserve  the  health  of  the  pupil. 


THE  HYGIENE  OF  THE  SCHOOLROOM 


CHAPTER  I 
THE  SELECTION  OF  A  SITE  FOR  A  SCHOOL  BUILDING. 

The  selection  of  the  site  for  a  school  has  an  important 
bearing  on  the  hygienic  condition  of  the  building.  The 
primary  consideration  should  be  the  drainage  capacity  of 
the  soil ;  if  possible,  the  land  should  be  high  and  dry. 
Marshes  or  springy  land  must  be  avoided,  else,  although 
the  greatest  care  in  construction  be  taken,  dampness  in  the 
cellar  will  most  certainly  result,  and  even  if  all  the  pre- 
cautions known  to  sanitary  science  are  used  in  all  other 
parts  of  the  building,  it  will  be  impossible  to  overcome 
the  evil  effects  of  this  dampness.  There  are  many  dis- 
eases which,  while  not  due  to  dampness,  are  fostered  and 
abetted  by  its  presence,  particularly  diphtheria,  typhoid 
fever,  consumption  and  rheumatism.  Headache  and 
languor  also  frequently  result  from  living  in  and  breath- 
ing a  damp  atmosphere. 

An  instance  of  unwise  selection  of  a  site  is  noted  in  a 
New  England  town,  where  a  schoolhouse  was  built  on  a 


'  '2          'The"  Hygiene  of  the  Schoolroom. 

.  side  hill  that  was  notoriously  springy.  More  than  twenty 
years  have  been  spent  unsuccessfully  in  trying  to  keep  a 
dry  cellar.  Water  forces  itself  in  during  the  rainy  season, 
filling  the  cellar  bottom  and  leaving  a  grimy  dampness  on 
the  side  walls  and  a  perceptible  dampness  in  the  rooms 
above.  The  result  has  been  numerous  complaints  of 
rheumatism  in  the  building  and  an  unnecessarily  high 
percentage  of  sickness. 

Made  ground,  that  is,  land  that  has  been  filled  in  with 
ashes,  rubbish,  and  animal  and  vegetable  refuse,  is  un- 
desirable school  property.  The  air  and  moisture  arising 
from  such  land  are  impregnated  with  foul  and  harmful 
gases,  which  are  bound  to  make  their  way  into  the  cellar ; 
and,  for  a  number  of  years,  at  least  until  the  refuse  is 
entirely  decomposed,  make  such  a  neighborhood  unhealth- 
ftil.  Where  possible,  a  good  gravel  soil  should  be  se- 
cured ;  if  this  cannot  be  had,  then,  in  order  of  preference, 
a  sand  soil  and  sandy  clay.  Clay  retains  moisture  very 
readily,  and  when  a  cellar  is  dug  in  such  soil  it  is  more 
than  likely  to  be  a  damp  one. 

A  school  should  be  far  from  confusing  noises,  such  as 
those  made  by  railroad  trains  and  certain  factories.  It 
is  also  unpleasant  to  be  located  near  industrial  establish- 
ments that  constantly  give  off  noxious  odors.  Further- 
more, the  lot  selected  for  a  school  building  should  be 


' 


Site  for  a  School   Building.  3 

large  enough  to  prevent  neighboring  structures  from  in- 
terfering with  the  necessary  light.  The  building,  as  a 
general  thing,  should  not  cover  more  than  half  the  lot. 
A  good  rule  to  follow  is  that  no  adjoining  structure 
should  be  nearer  than  twice  the  height  of  the  school  build- 
ing. 

In  laying  out  a  schoolyard,  at  least  thirty  square  feet 
should  be  allowed  for  each  pupil.  For  instance,  if  a  six- 
room  building  is  to  be  erected  to  accommodate  three  hun- 
dred pupils,  the  playground  should  contain  not  less  than 
9,000  square  feet.  In  the  larger  cities  it  will  naturally  be 
found  difficult  to  have  extensive  grounds  about  the  school 
building;  but,  wherever  feasible,  plenty  of  ground  for 
play  and  exercise  should  be  planned  for. 

Too  often,  however,  hygienic  conditions  are  ignored  in 
the  selection  of  a  school  lot  and  more  mercenary  considr 
erations  are  allowed  to  prevail.  Cost  becomes  a  great 
factor  in  the  decision,  and  often  a  school  is  located  in  one 
particular  place  because  the  land  is  cheap.  Or  the  cen- 
trality  of  a  site  may  determine  the  selection,  or  the  dislike 
of  property-holders  to  have  a  school  building  too  near 
residences,  the  school  being  looked  upon  as  a  very  poor 
neighbor.  But  the  importance  of  a  wise  selection  of  land 
for  a  school  should  rise  above  all  other  factors  in  the  de- 
cision, and  the  truth  should  be  borne  in  mind  that  no  lot 
is  too  good  for  school  purposes. 


CHAPTER  II 
THE  CONSTRUCTION  OF  SCHOOL  BUILDINGS 

We  shall  consider  the  construction  of  school  buildings 
entirely  from  a  hygienic  point  of  view.  The  general  out- 
lines and  appearance  of  the  building,  and  its  interior 
adornment,  have  received  exhaustive  attention  from 
architects;  the  artistic  aspect  of  the  subject  we  shall  leave 
to  those  better  qualified  to  do  it  justice.  Within  the  past 
ten  years,  it  is  true,  following  the  trend  of  other  profes- 
sions toward  specialization,  some  architects  have  been 
giving  careful  study  to  school  construction  and  have  pro- 
duced schools  containing  in  the  aggregate  more  sanitary 
improvements  than  had  been  worked  out  previously  in 
as  many  decades.  Experience,  however,  has  shown  that 
many  architects  have  not  as  yet  well  handled  the  subject 
of  school  construction,  and  that  too  often  such  consid- 
erations as  proper  lighting  and  ventilation,  proper  loca- 
tion of  cloakrooms  and  sanitary  closets,  are  neglected. 

The  construction  of  school  buildings,  indeed,  should 
receive  as  much  attention  from  the  sanitary  officer  as 
from  the  architect ;  and  when  the  two  shall  work  together, 


The  Construction  of  School   Buildings.      5 

we  may  hope  to  see  ideal  school  buildings.  We  should 
bear  in  mind  that  such  buildings  would  be  as  varied  as 
the  demands  of  different  communities.  The  building 
that  would  fill  the  needs  of  a  metropolis  would  not  be 
suitable  for  a  country  cross-roads  and  vice  versa.  There 
are  general  rules,  however,  that,  apply  in  all  cases. 

The  cellar  should  be  so  constructed  as  to  be  at  all 
times  dry;  the  top  of  the  foundation  should  be  at  least 
three  feet  above  the  ground  level,  in  order  that  plenty  of 
light  may  be  admitted  to  the  basement.  The  floors 
should  be  of  concrete  or  asphalt,  and  the  walls  of  cement. 
The  cellar  should  not  be  a  foul,  dark  storage  room  for  old 
rubbish,  but  a  clean,  ventilated,  and  well-lighted  room 
that  could  be  used  in  stormy  weather  with  safety,  as  a 
playground  for  the  children. 

It  is  not  wise  to  construct  high  buildings  for  school 
purposes  for  two  reasons :  first,  stair-climbing  is  not  a 
healthful  exercise,  especially  for  growing  girls;  and, 
secondly,  in  case  of  fire  the  danger  is  greater  than  in  a 
low  building.  Buildings  of  two  stories  high  should  be 
the  general  rule;  they  should  never  be  higher  than 
three  stories.  The  lowest  grades  should  be  assigned  the 
rooms  nearest  the  ground  floor.  In  many  of  the  larger 
cities  the  cost  of  land  is  such  an  important  factor  and  the 
school  population  so  dense  that  it  is  necessary  to  erect 
buildings  of  a  number  of  stories  in  height.  Of  necessity 


6  The  Hygiene  of  the  Schoolroom. 

the  playground  space  is  very  limited,  and  for  this  pur- 
pose the  roof  is  finished  in  such  a  manner  as  to  afford  a 
recreation  place  for  the  children.  In  such  cases  the  sides 
of  the  roof  are  of  course  well  protected  by  a  high  fence 
or  wall  to  avoid  accident  during  play.  In  many  schools 
much  pride  is  taken  in  these  roof  gardens,  which  are 
decorated  with  flowers  and  plants,  affording  pleasant 
places  for  the  children's  recreation. 

The  school  entrances  should  be  large  and  sufficient  in 
number.  The  corridors  must  be  roomy,  and,  with  the 
stairs,  should  be  fire-proof,  even  though  the  rooms  them- 
selves are  not  so.  The  stairs  should  be  at  least  five  feet 
wide,  built  with  a  landing  near  the  middle  of  each  flight. 
The  steps  should  be  of  uniform  box-like  shape  and  of 
equal  width :  triangular  steps  and  steps  over  eight  inches 
high  are  to  be  avoided. 

The  cloakrooms  or  wardrobes  should  not  be  a  part  of 
the  schoolroom.  This  latter  point  should  receive  par- 
ticular attention,  as  there  can  be  no  question  that  the 
outer  garments  of  the  children  are  a  favorite  hiding  place 
for  disease  germs.  Personal  observation  has  shown  that 
in  houses  where  contagious  diseases  exist,  the  outer  gar- 
ments receive  little  or  no  attention,  and  often  form  part 
of  the  covering  of  the  sick  one.  When  the  patient  re- 
covers, these  same  garments,  so  pregnant  with  dis- 
ease, are  taken  to  the  common  cloakroom  and  huddled 


FIG.    i. 
Standard  School  Wardrobes  in  a  School  Hall. 


8  The  Hygiene  of  the  Schoolroom. 

together  with  dozens  of  others,  which  thus  become  a 
most  excellent  medium  for  transmission  of  disease. 

A  model  cloakroom  should  be  separated  from  the 
schoolroom  and  connected  with  the  corridor.  It  should 
contain  individual  compartments,  or  lockers,  for  each 
pupil's  garments,  and  windows  should  be  so  arranged 
that  a  constant  supply  of  fresh  air  may  circulate  freely 
about  the  clothes  and  rid  them  of  the  disagreeable  stifling 
smell  that  so  often  clings  to  them  and  fills  the  schoolroom. 
The  cloakroom  should  not  be  kept  warm,  as  germs  thrive 
and  multiply  much  more  rapidly  in  a  warm  room  than  in 
a  cold  one. 

In  several  schools  in  England  there  are  drying  closets 
attached  to  the  cloakrooms,  for  use  on  damp  and  rainy 
days  for  drying  the  wet  shoes  and  outer  wraps  of  the 
pupils.  This  most  excellent  arrangement  could  well  be 
imitated  in  this  country.  Along  this  same  line,  it  would 
be  of  great  service,  especially  in  times  of  epidemics,  to 
have  a  small  air-tight  closet  or  room  where  garments, 
books,  and  all  other  articles  brought  from  home  to  school, 
could  be  thoroughly  fumigated.  Successful  fumigation 
can  easily  be  done  with  formaldehyde  vapor  and  with  a 
comparatively  inexpensive  apparatus. 

If  at  all  possible,  bathroom  accommodations  should  be 
provided  for  the  scholars.  Recently,  six  new  school- 


The  Construction  of  School   Buildings.       9 

houses  opened  in  Boston  had  well  appointed  bathrooms. 
The  teachers  reported  their  use  to  be  advantageous,  that 
the  daily  bath  was  invigorating  as  well  as  cleanly,  and 
stimulated  the  pupils  to  better  work. 

The  children  coming  from  the  poorer  homes  formerly 
were  denied  these  advantages,  and  often  their  bodies 
emitted  odors  which,  taken  in  the  aggregate  in  the  school- 
room, were  decidedly  unhealthful  and  made  a  room  diffi- 
cult to  ventilate  satisfactorily.  The  use  of  the  school- 
bath  obviated  this  unpleasant  feature. 

The  swimming  tank  is  most  to  be  desired,  as  in  addition 
to  its  sanitary  advantages  it  is  helpful  as  a  means  of  bene- 
ficial exercise.  The  matter  of  expense  often  stands  in  the 
way  of  its  adoption,  and  if  its  introduction  is  not  feasible 
the  ordinary  bath  tub,  or  shower  bath,  is  an  efficient  sub- 
stitute. 

The  proper  placing  of  water  closets  is  an  ex- 
ceedingly difficult  matter,  and  even  experts  differ  widely 
on  this  point.  Some  favor  placing  the  closets  in  the  base- 
ment or  elsewhere  within  the  building;  while  others  find 
positive  objection  to  having  the  closet  placed  any  nearer 
than  fifty  feet  to  the  main  building.  Much  can  be  said 
on  both  sides.  If  closets  are  placed  in  a  cold,  bleak  part 
of  the  lot,  many  children  will  refuse  to  respond  to  the  call 
of  nature,  and  will  suffer  the  ills  attendant  on  such  delay 
— constipation,  hemorrhoids,  etc.  On  the  other  hand, 


io         The   Hygiene  of  the  Schoolroom. 

there  is  difficulty  if  the  closets  are  in  the  building.  For 
example:  a  modern  schoolhouse  lately  examined  in  a 
New  England  town  was  found  to  have  been  most  care- 
fully planned — well  lighted,  well  ventilated — and  a  model 
school  building,  save  in  one  respect.  On  warm  days  in 
summer,  and  in  winter  when  a  strong  fire  was  kept  in 
the  basement,  an  odor  of  urine  permeated  the  whole 
building.  The  boys  were  undoubtedly  careless,  and  the 
waste  pipes  failed  to  carry  off  the  excreta  quickly  enough. 
The  best  plan  is  to  have  the  closets  connected  with  the 
basement  and  yet  not  in  it,  and  supplied  with  their  own 
ventilation  and  light. 

The  important  desiderata  in  a  plumbing  system  in 
school  buildings  are  the  rapid  and  thorough  removal  of 
the  waste,  and  the  establishment,  by  means  of  proper  fix- 
tures, of  a  complete  barrier  to  the  noxious  odors  and 
gases.  Where  the  system  is  slow  in  carrying  off  the 
waste,  decomposition  of  the  sewage  takes  place  and  sewer 
gas  forms.  School  children  are  noticeably  careless  in 
the  use  of  closets,  and  for  this  reason  many  schools,  par- 
ticularly those  for  children  of  the  younger  grades,  from 
first  to  fourth,  have  a  system  that  performs  automatic 
flushing  of  the  closets  every  five,  ten,  or  fifteen  minutes 
during  school  hours,  according  as  the  mechanism  is  ad- 
justed. 


The  Construction  of  School  Buildings.    11 

This  automatic  flushing  principle  may  be  applied  to  the 
individual  closets,  or  to  the  latrine  system,  which  is  a 
large  trough-like  repository  rilled  with  water  over  which 
a  number  of  seats  are  placed.  The  waste  products  are 
deposited  in  these  troughs  and  are  washed  out  automat- 
ically every  fifteen  minutes  or  half  hour,  or  at  the  jan- 
itor's convenience. 

The  objection  to  an  automatic  flushing  device  of  any 
description,  is  that  it  is  very  frequently  out  of  order,  and 
that  unpleasant  odors  are  about  the  closet  until  the  flush- 
ing takes  place. 

It  can  be  said,  without  reservation,  that  the  best  closet 
for  all  grades  of  children  is  the  one  that  flushes  every 
time  it  is  used,  either  by  means  of  the  chain  and  pull  or 
the  mechanism  that  operates  when  the  weight  of  the 
body  is  taken  from  the  seat.  There  are  many  closets 
that  have  all  the  desirable  points,  but  the  principal 
trouble  seems  to  be  in  finding  a  satisfactory  urinal  for 
the  boys.  This  should  be  constructed  of  slate  and  should 
be  trough-like  in  shape,  with  a  continuous  and  strong 
flow  of  water  through  it.  The  floor  should  be  of  slate 
for  at  least  six  feet  from  the  urinal,  and  this  part  requires 
continual  flushing  and  cleansing,  as  investigation  shows 
that  often  the  floor  about,  rather  than  the  urinal  itself,  is 
the  source  of  the  odor. 

A  system  that  commends  itself  to  some  and  is  in  prac- 
tical use  in  American  cities,  disposes  of  the  excreta  by 


12         The   Hygiene  of  the  Schoolroom. 

burning.  The  waste  products  are  deposited  on  an  iron  re- 
ceptacle and  at  regular  intervals  a  fire  is  built  underneath 
in  a  grate,  the  flue  of  which  is  connected  with  the  chimney. 
The  heat  rapidly  consumes  the  products,  which  pass  up 
the  chimney  in  smoke  and  gases.  This  is  not  a  system  to 
be  praised  and  should  be  thought  of  only  where  sewerage 
is  impossible.  In  country  towns,  of  necessity,  the  closet 
must  be  the  old-fashioned  earth  closet  in  a  remote  part 
of  the  lot ;  and  with  a  very  little  care  in  covering  in  fre- 
quently with  dry  earth  or  ashes,  it  serves  its  purpose  ad- 
mirably. The  teacher  should  never  be  reticent  in  speak- 
ing of  the  care  of  the  closets,  whether  they  are  in  the 
building  or  apart  from  it.  Pupils  should  be  taught  that 
nuisances  in  such  places  will  not  be  tolerated,  not  alone 
from  a  moral  point  of  view,  but  from  a  sanitary  one  as 
well. 

If  possible,  there  should  be  in  each  building  a  room 
for  gymnastic  purposes.  A  favorite  place  for  this  with 
many  architects  is  the  basement,  and  if  this  part  of  the 
building  is  properly  constructed  and  is  light  and  dry,  it 
will  not  be  an  undesirable  location.  Here  regular  gym- 
nastic work  and  exercises  under  the  supervision  of  the 
physical  instructor  can  be  carried  out.  A  classroom  with 
its  desks  and  seats  provides  quarters  too  cramped  for  the 
physical  instruction  work.  The  best  shape  for  an  exer- 


The  Construction  of  School   Buildings.    13 

else  room,  as  for  any  schoolroom,  is  an  oblong,  the  longer 
side  being  that  through  which  the  light  is  admitted. 

Many  states  have  carefully  drawn  specifications  that 
must  be  carried  out  in  school  construction  to  guard  against 
fire  and  overcrowding.  In  Massachusetts,  "the  law 
requires  that  a  copy  of  the  plans  of  every  public  building 
shall  be  deposited  wkh  the  inspector  of  factories  and 
public  buildings  of  the  district  in  which  such  building  is 
located  before  the  erection  of  the  building  is  begun,  which 
plans  shall  also  include  the  system  or  method  of  ventila- 
tion to  be  provided,  together  with  such  portion  of  the 
specifications  as  the  inspector  may  require.  The  plans 
usually  required  are  a  plan  of  each  floor,  including  the 
basement  and  the  attic,  if  the  attic  is  occupied,  and  a 
front  and  a  side  elevation,  and  also  plans  and  sectional 
detail  drawings  of  the  system  of  ventilation.  Further 
plans  may  be  required  by  the  inspector  if  deemed  by  him 
to  be  necessary. 

"In  planning  buildings  to  be  used  for  schoolrooms,  or 
places  of  assemblage  above  the  first  story,  provision  should 
be  made  for  at  least  two  stairways,  and  such  stairways 
should  be  as  far  apart  as  practicable.  No  such  stairway 
should  be  less  than  four  feet  wide  in  the  clear,  and  wind- 
ing steps  should  be  avoided.  The  height  of  rise  and 
width  of  tread  of  all  stairs,  measured  on  the  cut  of  the 


14         The  Hygiene  of  the  Schoolroom. 

stringer,  should  be  given  on  the  plans.  No  flight  of 
stairs  should  have  more  than  fifteen  steps  between  land- 
ings. The  main  stairways  from  places  of  assemblage 
should  have  a  width  of  not  less  than  twenty  inches  for 
every  hundred  persons  accommodated  therein.  Such 
stairways  should  be  railed  on  both  sides.  All  outside 
doors  to  such  buildings  should  open  outwardly." 

In  order  to  prevent  fire,  the  Massachusetts  building 
law  makes  further  specifications  as  to  the  construction 
details  of  buildings,  as  follows : 

"All  elevator  wells  and  light  shafts,  unless  built  of 
brick,  must  be  filled  in  flush  between  the  wooden  studs 
with  fire-proof  materials,  or  lined  with  metal,  or  plastered 
on  metallic  lathing,  as  may  be  directed  by  the  inspector, 
and  all  woodwork  inside  of  such  wells  or  shafts  be  lined 
with  tin  plate,  lock- jointed.  Where  floor  beams  rest  on 
partition  caps  or  on  girders,  wall  girts,  or  on  wooden 
sills  [the  space]  between  such  beams  from  the  caps, 
girders,  girts,  or  sills,  to  the  lining  floor  above  [must  be 
filled  in]  solid  with  brick  and  mortar  or  other  fire-proof 
material.  When  floor  beams  in  frame  buildings  rest  on 
ledger  boards,  each  floor  [must  be  thoroughly  fire- 
stopped]  with  brick  and  mortar  resting  on  bridging  pieces 
cut  in  between  the  studs,  or,  where  practicable,  on  the 
ends  of  lining  floor.  In  brick  buildings  the  space  be- 


The  Construction  of  School   Buildings.    15 

tween  the  furrings  on  the  outside  walls  or  brick  partition 
should  be  filled  flush  with  mortar  for  a  space  of  five 
inches  in  width  above  and  below  the  floor  beams  of  each 
story.  Where  basement  or  other  flights  of  stairs  are  en- 
closed by  partitions  of  brick  or  wood,  the  spaces  between 
the  studs  or  wall  furrings  must  be  so  fire-stopped  with 
brick  or  mortar  as  effectually  to  prevent  any  fire  from 
passing  up  between  such  studs  or  furring,  back  of  the 
stair-stringers.  The  soffits  of  all  such  enclosed  stairs, 
and  also  partitions  on  stairway  side,  must  be  plastered  on 
metal  lathing.  Where  a  building  is  occupied  above  the 
first  floor  for  any  purpose  [insert  statement  of  purposes 
referred  to],  and  the  lower  story  is  occupied  for  stores, 
or  other  purposes  not  connected  with  the  upper  floors, 
the  stairways  leading  to  such  upper  floors  must  be  en- 
closed with  brick  walls  or  with  wooden  partitions  filled 
solid  with  brick  laid  in  mortar  or  other  fire-proof 
material,  and  plastered  on  both  sides  on  metallic  lathing, 
and  all  doors  in  such  partitions  lined  with  tin  plate,  lock- 
jointed.  All  long  flights  of  stairs  [must]  have  two 
smoke-tops  in  each  flight,  properly  constructed.  No  pipes 
for  conveying  hot  air  or  steam  can  under  the  law  be 
placed  nearer  than  one  inch  to  any  woodwork  unless 
protected  to  the  satisfaction  of  the  inspector  by  suitable 
guards  or  casings  of  incombustible  material.  No  wooden 


1 6         The   Hygiene  of  the  Schoolroom. 

flue  or  air-duct  of  any  description  can  be  used  for  heat- 
ing or  ventilating  purposes.     A   space   of   at   least   one 
inch  [must]  be  left  between  all  woodwork  and  the  chim- 
neys ;  also  around  all  hot  air,  steam  and  hot  water  pipes ; 
these  spaces  around  chimneys  and  pipes,  where  they  pass 
through  floors,    [must]   be  stopped  with  metal  or  other 
fire-proof  material,   smoke-tight.     Steam  and  hot  water 
pipes   [must]   have  metal  sleeves  and  collars.     All  chan- 
nels and  pockets   for  gas,   water  and  soil-pipes    [must] 
be  made  smoke-tight  at  each  floor.     The  space  around 
all  metal  or  brick  ventilating  ducts  must  be  fire-stopped 
at  each  floor  with  m:tal  or  other  fire-proof  material,  as 
approved  by  the  inspector.     All  chimneys  [must]  be  plas- 
tered with  one  good  coat  of  brown  mortar,  on  the  outside 
of  brickwork,  from  cellar  to  roof.     The  ceiling  of  fur- 
nace or  boiler  and  indirect  radiator  rooms  must  be  plas- 
tered on  metal  lathing.     There  should  be  not  less  than 
one  foot  in  height  of  open  air  space  between  the  tops  of 
furnace  or    boiler    casing  and  the    ceiling.     The  entire 
cellar  ceilings  of  schoolhouses  and  other  buildings  used 
for  public  purposes  should  be  plastered  on  metallic  lath- 
ing." 


CHAPTER  III 
VENTILATION 

In  spite  of  the  fact  that  the  subject  of  ventilation  has 
received  exhaustive  treatment  from  writers  on  school 
sanitation,  that  the  dangers  of  ill-ventilated  rooms  have 
been  repeatedly  pointed  out,  and  that  systems  of  ventila- 
tion have  been  elaborated  and  perfected,  there  are  count- 
less schoolrooms  occupied  daily  in  which  the  air  is  not 
so  pure  as  in  an  ordinary  stable.  Many  of  these  are  in 
buildings  constructed  long  ago,  when  no  one  thought  of 
providing  any  other  means  of  changing  the  air  in  the 
schoolroom  than  the  doors  and  windows  offered.  Such 
buildings  are  hard  to  ventilate  without  causing  serious 
discomfort  to  those  who  are  seated  near  the  open  door  or 
window,  and,  in  consequence,  the  schoolroom  too  often 
goes  unaired.  But  not  only  in  old-fashioned  schools  is 
the  supply  of  fresh  air  inadequate  or  neglected :  even  to- 
day schoolhouses  are  being  built  with  little  or  no  regard 
to  ventilation. 

There  can  be  no  excuse,  however,  for  disregarding  the 
dangers  of  having  children  live  in  an  impure  atmosphere : 


1 8         The  Hygiene  of  the  Schoolroom. 

sanitary  literature  teems  with  warnings.  The  New  York 
Board  of  Health  estimates  that  forty  per  cent,  of  all 
deaths  are  attributable  directly  or  indirectly  to  bad  air. 
Dr.  A.  N.  Bell,  of  Brooklyn,  N.  Y.,  in  a  paper  read  be- 
fore the  Public  Health  Association  of  Philadelphia,  says : 
"The  depressed  state  of  the  organism  under  the  prevail- 
ing conditions  of  a  badly  ventilated  schoolroom  not  only 
predisposes  to  epidemic  diseases,  but  the  liability  to  and 
the  danger  of  all  diseases  are  intensified;  and  vicissi- 
tudes of  weather,  which  under  favorable  circumstances 
may  be  encountered  with  impunity,  under  these  depress- 
ing influences  become  dangerous  perils;  and  doubtless 
much  that  is  attributed  to  the  season  of  the  year  supposed 
to  be  predisposing  to  scarlet  fever,  measles,  whooping- 
cough,  diphtheria,  and  some  other  common  affections  of 
children,  is  due  to  the  same  cause." 

Dr.  James  Johnson,  in  his  "Diary  of  a  Philosopher," 
says :  "All  the  deaths  resulting  from  fevers  are  but  as  a 
drop  in  the  ocean  when  compared  with  the  number  who 
perish  from  bad  air."  Nor  can  there  be  any  doubt  of  the 
value  of  proper  ventilation.  Prof.  S.  H.  Woodbridge, 
of  the  Massachusetts  Institute  of  Technology,  in  his 
notes  on  "Ventilating  and  Heating,"  makes  clear  the 
effects  of  the  introduction  of  a  system  of  efficient  ventila- 
tion when  he  tells  us  that  by  this  means  "death  rates 


Ventilation.  19 

have  been  reduced  in  children's  hospitals  from  fifty  to 
five  per  cent.;  in  surgical  wards  of  general  hospitals, 
from  forty-five  to  thirteen  per  cent. ;  in  army  hospitals, 
from  twenty-three  to  six  per  cent.,  and  in  prisons,  from 
eighty  to  eight  per  cent." ;  and  Dr.  Oliver  Wendell 
Holmes,  in  his  "Medical  Essays/'  is  responsible  for  the 
statement  that  "a  simple  measure  of  ventilation  pro- 
posed by  Dr.  John  Clark  had  saved  more  than  sixteen 
thousand  children's  lives  in  a  single  hospital." 

Between  good  air  and  bad  there  is  more  difference 
than  might  be  thought.     Chemically  fresh  air  consists  of 

79       per  cent,  of  nitrogen,* 

20.96  per  cent  of  oxygen, 

.03  per  cent,  of  carbon  dioxide  (carbonic  acid  gas), 
with  traces  of  ammonia  (nitric)  acid  and  watery  vapor. 

Expired  air  contains : 

79.2  per  cent,  of  nitrogen  (very  little  change), 

15.4  per  cent,  of  oxygen  (a  loss  of  over  five  per  cent. 

of  this  life-giving  element). 

4.3  per  cent,  of  carbon  dioxide  (an  increase  of  over 
one  hundred  fold). 

Carbon  dioxide  in  excess  in  the  air  is  not  poisonous, 
as  was  formerly  believed,  although  when  a  great  deal  of 

*  One  per  cent,  of  what  was  considered  nitrogen  is  another  elementary  gas,  argon. 


2O         The  Hygiene  of  the  Schoolroom. 

this  gas  is  present,  as  in  the  air  at  the  bottoms  of  wells, 
the  air  is  irrespirable. 

But  air  also  contains  volatile  organic  substances,  which 
the  skin — by  a  so-called  "insensible  sweating,"  not  neces- 
sarily accompanying  moist  perspiration — and  the  lungs 
give  off.  These  organic  exhalations,  which  can  be 
readily  detected  by  the  nose  when  one  comes  into  a  close 
room  where  a  number  of  persons  are  sitting,  are  the 
deadly  principle  in  vitiated  air.  To  illustrate  the  poison- 
ous nature  of  the  exhalations  from  the  body,  the  follow- 
ing fact  is  cited :  A  four-year-old  child,  because  of  his 
good  health  and  physique,  was  selected  to  represent  the 
Infant  John  the  Baptist  in  an  allegorical  posing.  The 
child  was  stripped,  and,  to  heighten  the  effect,  his  entire 
body  was  covered  with  gold  bronze.  The  exhibition 
lasted  several  hours,  but  when  the  fete  was  over  no  effort 
was  made  to  remove  the  coating  and  the  following  day 
the  child  died.  The  covering  applied  to  the  body  sealed 
up  these  organic  substances,  which  were  absorbed  into  the 
system  and  caused  the  child's  death.  And  that  the  sub- 
stances given  off  by  the  lungs  are  actively  poisonous  has 
been  shown  by  Brown-Sequard.  He  found,  upon  taking 
the  exhaled  vapor,  condensing  it  into  liquid  form,  and 
injecting  it  into  the  artery  of  a  rabbit,  that  death  fol- 
lowed in  less  than  a  minute.  Certainly  these  same  toxic 


Ventilation.  21 

substances  in  circulation  in  the  air  to  an  abnormal  degree 
must  act  deleteriously. 

Pupils  soon  show  the  evil  effects  of  breathing  impure 
air.  Many  tire  quickly  in  school,  although  they  are  able 
to  work  with  ease  on  the  same  tasks  at  home.  The 
teacher  notices  that  although  the  children  work  quickly 
and  brightly  during  the  first  period  of  the  day,  an  unde- 
sirable transformation  takes  place  after  only  a  short  time 
in  the  vitiated,  unhealthful  atmosphere.  The  child  finds 
difficulty  in  application,  is  much  less  able  to  follow  out 
a  line  of  thought,  and  becomes  dull,  fretful  and  irritable. 
And  there  can  be  no  question  that  many  of  the  headaches 
attributed  both  by  parents  and  by  physicians  to  eye-strain 
and  too  close  application  to  study,  are  the  result  of  im- 
proper ventilation  of  our  schoolrooms. 

The  problem  seems  simple  enough,  for  there  is -plenty  of 
fresh  air  in  the  world.  The  difficulty  is  in  bringing 
about  a  continuous  and  regular  exchange  of  pure  for 
foul  air  in  school  buildings  without  causing  drafts. 

But  before  considering  the  practical  means  of  ventila- 
tion, we  should  estimate  the  proper  amount  of  air  space 
required.  A  conservative  and  yet  a  safe  allowance,  sup- 
posing the  schoolroom  to  be  twelve  feet  high,  would  be 
twenty  square  feet  of  floor  space  for  each  pupil.  Thus  a 
room  25  feet  x  30  feet,  giving  an  area  of  750  square  feet, 


22         The  Hygiene  of  the  Schoolroom. 

would  suffice  for  38  pupils.  Each  pupil  would  have  a 
cubic  air  space  of  237  feet,  which  is  very  near  the  gen- 
erally recognized  standard. 

There  are  two  methods  of  ventilation :  the  so-called 
natural  method,  by  which  fresh  air  is  admitted  di- 
rectly to  the  schoolroom  from  outside  by  means  of 
windows,  doors  and  other  openings;  and  the  artificial, 
by  which  a  definite  amount  of  air  is  first  warmed,  and 
then,  by  means  of  special  appliances,  introduced  into  the 
room,  being  finally  removed  when  no  longer  respirable. 
Two  systems  of  artificial  ventilation  are  in  use :  the  grav- 
ity system,  by  which  the  currents  of  air  are  kept  in 
motion  by  the  difference  in  the  weight  of  cold  and  hot 
air;  and  the  fan  system,  by  which  the  air  is  circulated 
by  means  of  a  forced  draft  from  a  rotary  fan.  As  to  the 
relative  merits  of  the  natural  and  artificial  methods,  there 
can  be  no  question — the  latter  is  always  to  be  preferred. 
By  either  the  gravity  or  the  fan  system  it  is  easy  to 
supply  2,000  cubic  feet  of  air  to  each  child  per  hour  (or, 
as  the  Massachusetts  standard  requires,  30  cubic  feet  per 
pupil  per  minute)  ;  with  only  doors  and  windows*4t  would 
be  impossible  to  supply  this  amount  without  creating 
strong  and  uncomfortable  drafts.  <v 

In  1881,  Mr.  Richard  Briggs,  a  civil  engineer  of 
Bridgeport,  Conn.,  made  an  elaborate  series  of  experi- 


Ventilation.  23 

ments  for  the  purpose  of  determining  at  what  position  in 
a  schoolroom  the  inlets  and  outlets  should  be  placed,  in 
order  to  produce  the  most  thorough  change  of  air  in  a 
given  time.  The  result  of  these  experiments  was  the  es- 
tablishing of  the  principle  that  the  warm  air  should  enter 
the  room  from  the  inner  walls,  at  a  point  six  or  eight 
feet  from  the  floor,  and  that  the  foul  air  should  be  taken 
out  from  the  bottom  of  the  room  on  the  same  side.  The 
results  obtained  from  these  experiments  were  published 
in  the  report  of  the  Connecticut  State  Board  of  Health 
for  1881,  and  the  system  there  recommended  was  em- 
ployed with  great  success  in  the  Bridgeport  High  School, 
which  was  built  the  same  year. 

The  Code  of  Regulations  of  the  Educational  Depart- 
ment in  England  contains  the  following  rules  to  be  ob- 
served in  planning  Public  Elementary  Schools :  "Apart 
from  windows  and  doors  there  should  be  provisions  for 
copious  inlet  of  fresh,  also  for  outlet  of  foul,  air ;  the  best 
way  of  providing  the  latter  is  to  build  for  each  room  a 
separate  air  chimney  carried  up  in  the  same  stack  with 
the  smoke  flues.  An  outlet  should  have  motive  power 
as  by  heat  or  exhaust,  otherwise  it  will  frequently  act  as 
a  cold  inlet.  The  principal  point  in  all  ventilation  is  to 
prevent  stagnant  air.  Particular  expedients  are  only 
subsidiary  to  this  main  direction.  Inlets  are  best  placed 


24         The  Hygiene  of  the  Schoolroom. 

in  corners  of  rooms  furthest  from  doors  and  fireplaces 
and  should  be  arranged  to  discharge  upwards  into  the 
rooms.  Inlets  should  provide  a  minimum  of  two  and 
one-half  square  inches  per  child,  and  outlets  a  minimum 
of  two  inches.  All  inlets  and  outlets  should  be  in  com- 
munication with  the  external  air.  Rooms  should,  in  ad- 
dition, be  flushed  with  fresh  air  about  every  two  hours. 
A  sunny  aspect  is  especially  valuable  for  children  and 
important  in  its  effects  on  ventilation  and  health." 

The  teacher  who  is  fortunate  enough  to  find  herself  in 
a  building  equipped  with  modern  ventilating  apparatus 
has  little  to  think  of  on  this  score  beyond  familiarizing 
herself  with  the  practical  workings  of  the  system;  for 
the  janitor  may  not  always  be  at  hand  in  an  emergency, 
and  the  teacher  then  needs  to  know  how  to  operate  the 
apparatus  herself.  In  some  cases,  for  example,  where 
fault  was  found  with  the  performance  of  one  or  another 
system  of  warming  and  ventilating,  the  trouble  was  found 
to  lie  in  the  ignorance  of  the  teacher,  who  had  closed  the 
wrong  openings.  But  properly  managed,  a  good  system 
of  artificial  ventilation  will  very  considerably  lighten  the 
all  too  heavy  burden  of  the  teacher's  responsibilities. 

If  artificial  ventilation  is  not  or  cannot  be  installed, 
however,  there  are  improvements  that  may  be  made  upon 
the  old-fashioned  practice  of  opening  wide  the  doors 


Ventilation.  25 

and  windows.  When  windows  have  to  be  used  without 
any  fixtures  for  interrupting  the  direct  flow  of  the  outside 
air,  much  less  discomfort  to  the  pupil  will  result  if  they 
are  opened  from  the  top.  But  it  is  wrong  to  expect  proper 
ventilation  in  a  crowded  room  from  doors  and  windows 
alone.  Accessory  means  can  be  easily  established,  as,  for 
instance,  by  making  several  openings  for  the  exit  of  air 
around  the  top  of  the  room,  and  others  for  the  entrance 
of  air  at  the  bottom.  These  openings  should  be  provided 
with  registers  that  can  be  opened  and  closed  at  will.  If  it 
is  necessary  to  use  the  windows,  it  is  desirable  to  employ 
some  form  of  the  numerous  window  ventilators  in  use. 
Some  are  merely  plain  strips  of  board  fitted  underneath 
the  lower  sash,  allowing  the  air  to  enter  upwards 
between  the  sashes.  Others  are  wooden  pieces  per- 
forated in  such  a  way  as  to  direct  the  current  of  entering 
air  upwards.  Another  is  a  device  of  glass  after  the  fashion 
of  a  Venetian  blind.  An  excellent  adjunct  appliance, 
efficient  in  its  place,  but  hardly  large  enough  to  supply  all 
the  air  required  in  a  schoolroom,  'is  a  ventilator  made  of 
glass  enclosed  in  a  wood  or  metal  frame,  fitting  any 
ordinary  window  anc  placed  in  adjustable  brackets  at  an 
angle  of  from  five  to  twenty  degrees.  It  can  be  readily 
adjusted  parallel  with  the  window,  and  can  be  attached 
or  removed  without  causing  any  defacement  to  window 


26         The  Hygiene  of  the  Schoolroom. 

sash  or  frame.  By  its  means,  the  fresh  incoming  air  is 
deflected  towards  the  centre  of  the  ceiling,  where  it  meets 
the  warmer  air,  with  which  it  becomes  thoroughly  mixed. 
In  this  way  a  good,  free  circulation  is  produced  without 
subjecting  persons  in  the  room  to  drafts. 


FIG.    2. 

There  are  numerous  tests  for  determining  the  relative 
amount  of  impurities  in  the  air,  but  as  all  are  very 
difficult  to  perform  with  the  material  at  hand  in  an 
ordinary  schoolroom,  they  are  left  for  text-books  on  the 
subject  of  ventilation.*  The  teacher  will  seldom  need  to 
use  anything  but  her  olfactory  nerves  to  determine  that 

*  In  this  country  Mr.  Gilbert  B.  Morrison  has  a  very  carefully  prepared  and  valuable 
work  on  this  subject. 


Ventilation.  27 

the  ventilation  is  bad.  The  odor  from  the  impurities  of 
the  air  will  often  be  increased  by  the  odor  of  fetid  dis- 
charges from  the  ear,  of  decaying  teeth,  and  of  sweaty 
feet ;  and  the  teacher  should  have  no  hesitation  in  search- 
ing out  the  source  of  such  annoyances,  and  seeing  that 
they  are  remedied  as  soon  as  possible.  In  all  these  cases, 
with  the  possible  exception  of  prolonged  discharges  from 
the  ear,  cleanliness  is  all  that  is  required.  An  unpleasant 
odor  from  a  chronic  ear.  trouble  should  be  a  sufficient 
cause  for  the  excusing  of  a  child  from  school.  The  air 
must  be  kept  pure  and  sweet  at  all  costs,  and  the  teacher, 
in  addition  to  seeing  that  the  artificial  ventilation  works 
as  it  ought,  should  seize  every  opportunity,  as  at  recess 
and  lunch  hour,  for  thoroughly  renewing  the  air  by 
opening  doors  and  windows. 

At  this  point  it  would  be  well  to  insist  that  the  abolition 
of  the  old-time  ten  or  fifteen  minute  recess  was  a  serious 
error.  It  offered  an  excellent  opportunity  to  air  all  the 
rooms  thoroughly  and  afforded  a  breathing  spell  for  the 
pupils.  There  was  also  time  to  give  the  tired  brain  a 
rest,  to  ease  the  eye  strain,  and  to  relax  the  wearied  and 
cramped  muscles.  But  within  the  past  few  years  the 
recess  in  many  schools  has  been  abolished  as  being  old- 
fashioned  and  exceedingly  difficult  to  carry  out,  because 
it  interfered  with  school  order.  The  omission  of  the 


28         The  Hygiene  of  the  Schoolroom. 

recess  shortened  the  day's  work  of  the  teacher,  it  is  true, 
but  it  took  from  the  pupil  a  very  refreshing  period.  The 
school  hours  should  be  interrupted  during  both  sessions 
for  fifteen-minute  recesses,  or  when  there  is  but  one  ses- 
sion, there  should  be  a  recess  of  no  less  than  thirty 
minutes.  In  Germany  there  is  a  legal  requirement  de- 
manding forty  minutes  intermission,  exclusive  of  gym- 
nastics, for  every  five  hours  of  school  work. 

Governor  Peck,  of  Wisconsin,  once  wrote  an  article  on 
the  abolition  of  the  recess  in  his  own  characteristic  man- 
ner. He  says : 

"Sometimes  it  looks  as  though  the  school  officials  were 
overdoing  the  thing  in  trying  to  make  the  schools  of  the 
present  day  as  different  as  possible  from  the  old  schools, 
where  the  fathers  and  the  grandfathers  got  their  educa- 
tion. The  last  'improvement'  that  is  suggested  by  school 
boards  in  some  places  is  to  do  away  with  the  recess  in 
the  middle  of  the  forenoon  and  the  middle  of  the  after- 
noon, thus  compelling  the  scholars  to  stay  in  the  heated 
schoolroom  from  9  o'clock  in  the  morning  until  noon, 
and  all  the  afternoon  without  a  minute  of  rest.  If  the 
abolition  of  the  recess  does  not  raise  up  a  race  of  people 
with  nervous  headaches  it  will  be  a  miracle.  The  old 
recess!  Good  gracious!  it  was  the  recess  that  kept  the 
boys  and  the  girls  from  dying  in  their  tracks. 


Ventilation.  29 

"The  recess  in  school  is  like  the  sherbet  served  in  the 
middle  of  a  banquet ;  it  aids  the  digestion  like  the  blanched 
almonds  and  the  celery  and  the  olives.  If  the  banqueter 
sat  and  ate  of  the  solids  all  an  evening,  and  never  had  the 
rest  that  comes  with  the  et  ceteras,  he  would  die  of 
apoplexy  before  the  speaking  began.  If  the  scholar 
studies  all  the  time  until  his  head  whirls  his  brain  will 
become  clogged.  When  you  stop  the  recess  you  might 
as  well  seal  up  the  brain  arid  put  it  in  a  bottle  of  alcohol. 
The  boy  and  the  girl  have  got  to  have  a  time  to  cut  the 
string  that  holds  the  cork  down,  and  let  the  wolf  howl." 


CHAPTER  TV 
HEATING 

The  temperature  commonly  accepted  as  proper  for  a 
schoolroom  is  68°  F,  and  should  not  be  al^wed  to  rise 
over  7O°'F.  Two  thermometers  should  be  placed  in  the 
extreme  corners,  as  the  temperature  at  the  forward  part 
of  the  roon,,  if  heated  by  a  stove,  or  at  the  registers  or 
radiators,  will  often  be  above  the  required  point,  while 
that  of  the  distant  parts  of  the  room  is  considerably  below. 
The  temperature  should  not  vary  more  than  three  degrees 
in;  any  part  of  the  room. 

Residences,  places  of  business,  factories  and  school- 
rooms are  ordinarily  kept  too  warm,  often  at  8o°.F;  and 
children  who  are  accustomed  at  home  to  a  temperature  of 
80°  F  will  find  discomfort  in  sitting  in  the  schoolroom  at 
68  °F.  But  constant  living  in  such  an  overheated  atmos- 
phere renders  one  unable  to  stand  any  exposure  without 
contracting  colds  and  catarrhal  affections.  It  has  far 
more  to  do  with  the  great  increase  in  New  England  of 
such  affections  than  has  the  much-blamed  changeable 
climate  Indeed,  many  hygienists  of  repute,  principally 


Heating.  31 

Europeans,  advocate  a  much  lower  average  heat  in  the 
schoolroom  than  that  here  suggested,  some  recommending 
a  temperature  of  6i°F,  and  others  a  temperature  even  as 
low  as  50°  F.  In  America  conditions  are  different, 
and  it  would  not  be  wise  to  keep  the  minimum  tem- 
perature under  68° F.  One  cannot  suffer  from  cold  in  a 
room  at  68° F;  yet  temperature  taken  in  over  seventy 
schoolrooms  during  the  winter  months  averaged  78°  F, 
ranging  from  65  F  to  85 °F  in  several  rooms.  In  some 
instances,  when  too  great  a  degree  of  heat  was  found,  the 
teachers  confessed  to  liking  a  very  warm  room.  However, 
personal  preferences  should  be  dropped  in  the  interest  of 
the  school  as  a  whole ;  and  this  interest,  we  repeat,  is  best 
served  by  maintaining  a  temperature  which  does  not  vary 
more  than  two  degrees  from  the  normal  point  of  68°  F. 

Every  school  should  have  its  rules  regulating  the  tem- 
peratures of  the  room  in  cold  weather.  If,  at  the  opening 
of  school  work,  the  thermometer  does  not  register  60  °F, 
the  school  should  be  dismissed.  If  the  thermometer  is 
60°  F  or  thereabouts,  with  a  probable  rising  temperature, 
the  pupils  may  be  kept  without  danger.  The  first  part  of 
the  day's  work  could  be  advisedly  given  to  physical  exer- 
cises. 

The  methods  of  supplying  heat  are  two,  direct  and  in- 
direct. By  the  direct  system  the  heat-supplying  force  is 


32         The   Hygiene  of  the  Schoolroom. 

contained  in  the  room  itself — a  stove,  an  open  fireplace,  or 
the  radiators  of  a  steam  or  hot  water  plant.  When  a 
stove  is  used,  great  care  devolves  upon  the  teacher  to  see 
that  no  gases  are  given  off  and  that  a  steady,  constant 
heat  is  furnished,  not  too  intense  for  those  nearest  the 
stove.  For  their  protection,  it  is  a  good  plan  to  use  fire 
screens.  In  a  small  building,  the  open  fireplace  can  be 
advantageously  used,  since  it  also  serves  as  an  excellent 
means  of  ventilation.  The  principal  objection  to  the 
open  fireplace  is  the  great  waste  of  heat  in  the  chimney. 
.The  indirect  system  consists  in  warming  fresh  air  out- 
side the  room  and  introducing  into  the  room  the  air  so 
warmed.  At  present  three  methods  are  in  general  use 
— steam,  hot  water,  and  warm  air  furnaces.  Each  of 
these  methods  has  many  advocates  and  is  vigorously  up- 
held as  the  best.  One  or  another  of  the  indirect  systems 
should  always  be  used  when  possible,  as  a  more  equable 
temperature  can  be  kept  and  results  in  less  distraction  to 
pupil  and  teacher.  In  a  steam  plant,  the  fire  heats  the 
iron,  the  iron  the  water;  steam  is  generated  and  is  con- 
ducted from  the  boiler  to  the  heating  chamber,  in  which 
it  heats  iron  again,  and  the  iron  then  warms  the  air  for 
distribution.  The  action  of  a  hot  water  system  is  sim- 
ilar, except  that  steam  is  not  generated,  and  that  the  water 
is  conducted  to  the  heating  chamber  at  a  lower  tem- 


Heating.  33 

perature,  necessitating  a  much  greater  radiating  surface 
to  warm  the  same  amount  of  air.  In  the  warm  air  fur- 
nace the  fire  heats  the  iron,  and  the  iron  warms  the  air, 
which  then  passes  directly  to  the  point  of  distribution. 

The  choice  of  a  system  of  indirect  heating  will  vary 
with  the  size  of  the  building.  A  two,  four  or  six  room 
building  can  be  heated  very  readily  with  a  hot  air  appar- 
atus. A  building  with  more  rooms  requires  a  steam  or 
hot  water  heating  plant  or  a  combination  of  hot  air  and 
steam. 

An  important  point  favoring  the  hot  air  furnace, 
where  available,  is  the  simplicity  of  its  operation.  The 
ordinary  janitor  for  a  school  building  is  too  often  selected 
because  of  his  inability  to  perform  any  other  work  in  the 
community.  Instead,  one  who  has  charge  of  a  heating 
apparatus  that  might  by  neglect  become  a  source  of  dan- 
ger, should  be  a  carefully  selected  man,  fully  equipped 


NOTE.  The  manner  in  which  the  children  are  fed  and  clothed  has  a  great  deal  to  do 
with  their  power  to  withstand  cold.  Examinations  made  during  the  winter  months 
showed  that  a  number  of  pupils  were  very  scantily  clothed.  Some  had  no  undervests 
and  the  other  garments  were  of  the  flimsiest  nature.  The  teacher  should,  of  right, 
investigate  such  matters  as  these,  and  if,  as  is  often  the  case,  the  parents  are  unable  to 
remedy  the  matter,  it  should  be  called  to  the  attention  of  the  superintendent  to  report 
to  the  poor  commissions.  Badly-worn  shoes  and  wet  feet  should  be  looked  after  and 
no  pupil  should  be  seated  at  the  daily  work  who  has  wet  feet.  Some  means  of  drying 
the  shoes  and  stockings  should  be  devised,  as  there  is  nothing  more  harmful  than  sitting 
for  hours  with  damp  and  wet  feet. 


34         The  Hygiene  of  the  Schoolroom. 

for  all  the  branches  of  his  work,  and  invariably  sober  and 
industrious. 

The  following  requirements  in  regard  to  heating  (and 
ventilating)  apparatus  are  enforced  by  the  state  of  Massa- 
chusetts : 

1.  That  the  apparatus  shall,  with  proper  management, 
heat  all  the  rooms,  including  the  corridors,  to  70°  F  in 
any  weather. 

2.  That,  with  the  rooms  at  70°  and  a  difference  of 
not  less  than  40°  between  the  temperature  of  the  outside 
air  and  that  of  the  air  entering  the  room  at  the  warm- 
air  inlet,  the  apparatus  shall  supply  at  least  thirty  cubic 
feet  of  air  per  minute  for  each  scholar  accommodated  in 
the  rooms. 

3.  That  the   supply  of  air  shall   so  circulate   in  the 
rooms  that  no  uncomfortable  draft  shall  be  felt,  and  that 
the  difference  in  temperature  between  any  two  points  on 
the  breathing  plane  in  the  occupied  portion  of  a  room 
shall  not  exceed  3°. 

4.  That  vitiated  air  in  amount  equal  to  the  supply 
from  the  inlets  shall  be  removed  through  the  ventiducts. 

5.  That  the  sanitary  appliances  shall  be  so  ventilated 
that  no  odors  therefrom  shall  be  perceived  in  any  por- 
tion of  the  building. 


CHAPTER  V 
SCHOOL  FURNITURE 

The  average  child  is  employed  at  school  work  during 
the  years  from  five  to  fifteen.  This  particular  period  is 
the  growing,  or  formative,  age  of  the  child.  Many  of 
the  bones  by  the  fifth  year  are  in  a  very  imperfect  state 
of  development;  a  considerable ' portion  of  each  bone  is 
still  composed  of  cartilage,  which  is  very  easily  moulded 
into  or  out  of  shape.  In  succeeding  years  the  bone  more 
and  more  displaces  the  cartilage,  and  not  until  about  the 
age  of  puberty  are  the  long  bones  and  spinal  column 
fully  matured.  Habit  during  this  formative  period  will 
yield  permanent  after-effects  of  either  good  or  evil,  as  the 
case  may  be. 

At  this  time  in  life  children  should  be  taught  to  stand 
correctly,  to  walk  correctly,  and  to  sit  correctly.  In 
standing,  the  shoulders  should  be  thrown  back,  the  chest 
extended,  and  the  head  held  erect.  The  heels  should  be 
together,  the  toes  extended,  and  the  weight  evenly  dis- 
tributed upon  both  legs.  In  walking,  the  same  correct 
posture  should  be  maintained  and  an  effort  made  to  take 


FIG.   3. 

Illustrates  a  desk  too  high  for  the  child,  causing  elevation  of  the  right 
shoulder  in  writing  and  a  corresponding  curve  in  the  spinal  column. 


School   Furniture.  37 

even,  graceful  steps  with  feet  well  lifted  from  the  ground 
at  each  step. 

Both  standing  and  walking  can  be  improved  at  will; 
but  in  seating  the  children  a  more  difficult  problem  is  en- 
countered. Certainly  every  one  must  regard  the  old- 
fashioned  bench,  or  box  form,  as  a  hopeless  anachronism ; 
yet  doubtless  very  many  children  to-day  suffer  from 
the  effects  of  badly  made  school  furniture — as  unsuitable, 
in  fact,  as  that  which  Charles  Lamb  describes : 

"Oh !  how  I  remember  our  legs  wedged  into  those  un- 
comfortable sloping  desks,  where  we  sat  elbowing  each 
other,  and  the  injunctions  to  attain  a  free  hand,  unat- 
tainable in  that  position." 

The  seat  and  desk  for  each  pupil  should  be  most  care- 
fully looked  after;  for  medical  works  are  filled  with 
words  of  warning  against  the  use  of  ill-fitting  school  fur- 
niture. Many  eminent  physicians,  especially  in  Europe, 
have  given  a  great  deal  of  study  to  this  very  evil,  and, 
as  a  result,  have  devised  various  desks  and  seats  to  rem- 
edy the  defect.  According  to  Dr.  Farner's  theory,  a  pu- 
pil while  sitting  at  a  desk  improperly  constructed  invol- 
untarily assumes  an  injurious  position.  Often  the  injury 
is  caused,  during  writing  and  reading  exercises,  by  the 
pupil's  turning  his  head  to  the  front  or  left  while  writing, 
and  downwards  while  reading.  The  bad  results  that 


FIG.    4. 

Illustrates  too  great  space  between  the  seat  and  desk,  causing  pupii  to 
stoop  too  much,  inducing  round  shoulders. 


School  Furniture.  39 

may  follow  from  putting  children  into  seats  too  high  and 
large  for  some,  too  small  and  low  for  others,  are  near- 
sightedness,*  round  shoulders,  curvature  of  the  spine, 
difficulty  of  respiration,  distortion  of  the  upper  part  of 
the  body,  pains  and  tingling  sensations  in  the  feet. 

The  danger  from  bad  positions  lies  in  the  fact  that 
they  remove  the  centre  of  gravity  of  the  body  or  of  the 
head  from  its  natural  point  of  support.  It  is  essential 
that  the  centre  of  gravity  of  the  body  be  supported  by  the 
seat  just  as  it  is  supported  by  one's  feet  while  standing. 
This  is  impossible,  however,  if  cramped  or  stooping  posi- 
tions are  taken,  as  that  throws  the  centre  of  gravity  for- 
ward to  the  right  or  left,  as  the  case  may  be.  When  a 
person  sits  erect,  this  centre  of  gravity  is  directly  over 
the  spinal  column,  and  the  head  itself  is  supported  and 
balanced  by  the  muscles  of  the  neck.  But  all  this  is 
changed  by  any  forward  movement,  for  then  the  centre 
of  gravity  of  the  head  moves  forward  out  of  its  natural 
position,  and  the  head  must  therefore  be  supported  and 
balanced  by  the  help  of  a  strong  tension  of  the  muscles  of 
the  back  of  the  neck.  When  the  muscles  which  support 
the  head  become  tired,  the  head  droops  at  once  into  an 
unnatural  position  and  the  shoulders  become  stooped. 


*  The  normal  reading  distance,  measured  from  the  pupil's  eye  to  the  book,  should  be 
fourteen  inches  ;  children  who  show  any  considerable  variation  from  the  normal  should 
be  looked  upon  as  near-sighted  or  far-sighted. 


FIG.    5. 

Illustrates  a  very  common  fault  in  school  furniture,  a  too  high  seat.  The 
child  is  unable  to  rest  the  limbs  on  the  floor  and  leans  over  on  the  desk 
for  support. 


School  Furniture.  41 

The  more  common  defects  of  school  furniture,  as 
enumerated  by  Dr.  D.  F.  Lincoln,  of  Boston,  are : 

"First,  the  desk  may  be  too  high  for  the  child's  sitting 
height,  causing  an  excessive  elevation  of  the  shoulder 
of  the  hand  which  the  child  will  write  with,  usually  the 
right.  In  ^tempting  to  get  the  elbow  on  the  high  desk, 
the  shoulder  is  elevated,  the  corresponding  one  lowered, 
and  the  spinal  column  tilted. 

"Second,  the  desk  may  be  too  low,  causing  the  child  to 
stoop  forward.  This  causes  the  neck  to  flex  upon  the 
body,  producing  interference  of  circulation  from  the 
head,  congestion  resulting,  which  interferes  with  the 
eyes.  This  same  fault  causes  round  shoulders  from  the 
continued  stooping  to  be  sufficiently  near  the  work. 

"Third,  desk  too  far  from  seat,  with  stoop  of  the  body, 
injuring  the  eyes.  Danger  here  is  in  injuring  the  health 
by  compression  of  the  abdomen  and  chest,  dyspepsia, 
small  chests  and  round  shoulders. 


NOTE.  Most  authorities  concede  that  better  positions  in  the  seat  are  maintained  by 
the  child  in  writing  with  the  vertical  method  than  with  the  old  slant  method.  It  is  ad- 
visable that  the  desk  lid  should  be  movable  as  a  shorter  distance  is  needed  in  writing 
than  in  reading. 

NOTE.  In  speaking  of  school  furniture  we  call  the  vertical  space  between  the  rear 
edge  of  the  pupil's  desk  and  the  plane  of  the  seat  the  "difference."  It  can. be  ascer- 
tained by  measuring  the  distance  from  the  seat  bones  to  the  elbow  when  the  arm  hangs 
down  "  Distance  "  is  the  special  term  for  the  horizontal  space  between  the  rear  edge 
of  the  desk  and  front  edge  of  the  seat. 


FIG.    6. 


Illustrates  a  too  small  "  distance  "  between  the  seat  and  desk,  causing 
pressure  on  chest  and  stomach. 


School  Furniture.  43 

"Fourth,  flat  desk  lid,  interfering  with  freedom  of 
writing,  disadvantageous  as  respects  receiving  the  light 
and  compelling  the  child  to  hold  up  his  book  in  order  to 
see. 

"Fifth,  seats  too  high,  so  that  the  feet  are  not  supported 
and  the  legs  grow  weary. 

"Sixth,  insufficient  support  for  the  back,  causing  fatigue 
and  improper  attitudes  and  consequent  tendency  for  the 
spine  to  yield  and  take  a  side  curve. 

"Seventh,  seat  not  hollowed  suitably,  causing  pain  and 
restlessness. 

"Eighth,  a  well-proportioned  desk  and  seat,  but  not 
adapted  to  size  of  the  child  using  it." 

In  a  proper  seat  the  child  should  be  able  to  sit  back 
firmly  and  have  both  heel  and  sole  touch  the  floor  fairly, 
with  the  upper  and  lower  leg  forming  a  perfect  right 
angle.  Foot-rests  are  particularly  tiresome,  as  they  limit 
too  narrowly  the  motion  of  the  child's  feet.  The  back- 
rest should  follow  in  shape  the  normal  curves  of  the 
spine  and  should  not  reach  higher  than  the  lower  border 
of  the  shoulder  blades,  for  otherwise  the  free  movements 
of  the  arms  and  shoulders  are  interfered  with. 

School  furniture  of  the  stationary  kind  requires  the  use 
of  different  sizes  of  seats  and  desks  to  fit  the  needs  of  the 
pupils;  furniture,  on  the  other  hand,  so  devised  that  the 


FIG.    7. 

Illustrates  a  desk  and  chair  too  small  for  pupil's  size,  causing  cramping 
of  the  lower  limbs. 


School  Furniture.  45 

seat  and  desk  can  be  adjusted  to  proper  size  by  raising 
and  lowering,  is  now  in  very  general  use,  and  no  other 
kind  considered.  Physicians,  oculists,  and  educators 
everywhere  are  united  in  advocating  the  use  of 
adjustable  school  desks,  and  surely  some  importance 
should  be  attached  to  their  advice,  for  their  daily  experi- 
ence brings  additional  proof  of  the  serious  damage  re- 
sulting from  fitting  the  child  to  the  seat  rather  than 
fitting  the  seat  to  the  child.  Dr.  Charles  L.  Scudder,  of 
Boston,  an  earnest  student  of  school  furniture,  has  made 
extensive  examinations  in  the  schoolroom,  disclosing  the 
following  facts : 

"Examination  made  of  thirty-seven  schoolrooms  in 
Boston  showed  that  only  one-third  were  provided  with 
two  sizes  of  desks  and  seats.  In  every  instance  where 
these  two  sizes  were  found,  there  were  only  a  few  of  the 
second  size,  and  the  difference  in  these  from  the  others 
was  scarcely  noticeable.  It  was  found  that  the  rule  in 
grammar  schools  was  that  the  seats  were  of  the  same  size 
throughout  the  room  and  that  these  were  placed  at  desks 
of  uniform  height.  In  the  matter  of  age  there  were 
differences  in  schoolrooms  of  from  five  to  nine  years. 
Children  with  seven  years  difference  in  age  and  with 
fifty-seven  centimeters  difference  in  height  were  found 
seated  at  the  same  size  desks  in  seats  of  equal  height,  but 


4.6         The  Hygiene  of  the  Schoolroom. 

xhe  results  of  such  a  condition  are  faulty  and  dangerous 
positions  assumed  in  sitting  and  later  in  standing,  and 
these  positions  unavoidably  lead  to  serious  deviations  of 
the  spine  and  to  an  unnatural  elevation  of  the  shoulders. 
These  produce,  with  growing  children,  serious  deform- 
ities. They  are  caused  by  desks  which  are  too  high  or 
too  low  for  the  pupil's  lower  leg,  by  seats  too  long  or  too 
short  for  the  thigh,  by  distance  from  the  desk  to  the  seat 
either  too  short  or  too  long.  It  was  clearly  brought  out 
in  this  investigation  that  the  method  of  seating  in  school- 
houses  was  defective  in  the  extreme,  leading  to  permanent 
deformity  in  the  spine  and  distorted  eyesight.  In  this 
respect,  Boston  is  far  behind  other  cities,  such  as  Worces- 
ter, Springfield  and  Lowell.  In  these  places  it  has  been 
recognized  that  the  only  remedy  for  the  evil  lies  in  pro- 
viding adjustable  desks,  so  that  the  pupil  may  be  per- 
manently fitted  with  the  desk  he  occupies,  and  nothing 
but  adjustable  desks  are  purchased.  The  director  of 
physical  training  in  the  public  schools  at  Woonsocket, 
R.  L,  in  1901,  after  examining  about  four  thousand 
pupils,  reported  that  over  two  hundred  children  could  not 
touch  their  feet  to  the  floor  in  any  seat  in  their  respective 
rooms,  and  that  twenty-six  children  were  too  large  for 
the  seats  given  them.  In  six  rooms,  over  fifty  per  cent, 
could  not  touch  the  heels  to  the  floor,  the  largest  num- 


48         The  Hygiene  of  the  Schoolroom. 

ber  of  misfits  in  any  one  room  being  thirty-two  out  of 
forty-six.  Blocks  were  provided  in  many  cases,  but  the 
fact  remains  that  much  of  the  school  furniture  is  too  large 
for  the  children  who  attend  school  in  this  city." 

Before  the  National  Academy  of  Medicine,  Dr.  John 
Jay  Moore  read  a  paper  on  school  furniture  in  which  he 
said :  "I  will  endeavor  to  explain  what  has  been  the  cus- 
tom in  seating  our  schools,  and  then  you  can  readily  see 
where  the  difficulty  exists.  When  we  have  had  a  new 
building  to  seat,  the  grade  of  the  school  and  the  num- 
ber of  pupils  to  be  accommodated  in  each  room  is  ascer- 
tained by  the  superintendent,  and  the  approximate  ages 
of  the  children  who  will  attend  the  school  of  a  given 
grade.  From  this  the  size  of  the  seats  and  desks  to  be 
used  are  obtained,  regardless  of  the  heights  of  the  pupils 
in  the  different  rooms.  In  the  rooms  in  the  modern 
buildings  there  are  placed  fifty-six  seats  expected  to 
accommodate  pupils  from  the  age  of  eleven  to  fifteen, 
and  in  different  rooms  ranging  in  height  from  five  feet 
eight  inches  to  four  feet  four  inches,  with  all  the  inter- 
mediate sizes.  These  fifty-six  pupils,  if  the  seats  are  all 
occupied,  are  expected  to  be  perfectly  seated  with  but 
two  or  three  different  sizes  of  seats.  We  find  in  one  seat 
a  pupil  with  the  chin  but  little  above  the  desk ;  in  another 
we  find  the  desk  so  low  that  the  pupil,  when  sitting  in 


School  Furniture.  49 

an  upright  position,  can  not  see  his  work,  thus  being 
compelled  to  assume  a  position  which  will  produce  a 
crooked  back  or  ruin  his  eye-sight.  Still  we  find  another 
little  fellow  who  cannot  touch  the  floor  with  his  feet,  thus 
losing  the  support  to  the  spine  which  becomes  so  neces- 
sary to  the  welfare  of  the  child  at  this  age. 

"For  the  lower  extremities  at  nine  years,  those  of  the 
girls  are  longer,  at  eleven  shorter,  and  from  twelve  to 
fourteen  again  longer.  At  fifteen  the  lower  extremities 
of  the  girl  almost  cease  growing,  while  those  of  the  boy 
increase  by  four  inches  between  the  ages  of  fourteen  and 
nineteen.  The  methods  by  which  the  seat-makers  arrive 
at  the  sizes  necessary  leave  all  the  scientific  points  out  of 
their  calculations,  and  give  us  an  arbitrary  size  for  all 
pupils  of  a  given  age  and  grade.  The  bad  effects  that 
result  from  the  disproportion  of  the  seat  to  the  child  are 
bad  positions  assumed  in  sitting,  and  a  child  that  is  com- 
pelled or  allowed  to  assume  faulty  positions  while  sitting 
will  assume  faulty  attitudes  in  standing.  The  effect  of  as- 
,  suming  malpositions  repeatedly  tends  to  make  permanent 
and  to  exaggerate  these  malpositions,  which  amount  in 
time  to  permanent  deformity. 

"In  school  children  we  have  to  deal  with  developing 
spines,  which  are  soft  and  capable  of  being  molded.  It 
has  been  demonstrated  that  as  long  as  the  weight  of  the 


50         The  Hygiene  of  the  Schoolroom. 

shoulders  and  head  falls  on  the  spine  symmetrically  only 
a  posterior  bending  will  appear.  The  moment  this  sym- 
metrical impression  is  changed  there  is  a  tendency  for  the 
bones  and  ligaments  to  become  molded  and  to  grow  into 
deformed  shapes.  The  fact  of  the  pupils  being  improperly 
seated  causes  in  many  cases  lateral  curvature.  The  chil- 
dren in  trying  to  get  into  comfortable  positions  throw  the 
spine  out  of  plumb,  thus  predisposing  the  spine  to  all 
forms  of  curvature. 

"Time  will  not  permit  me  to  go  into  all  the  details  of 
the  positions  which  produce  the  stooped  and  round 
shoulders,  as  well  as  those  that  affect  the  eyesight.  The 
important  question  now  is,  'How  can  this  matter  be  rem- 
edied?' Beyond  a  question,  the  adjustable  school  desk 
is  the  only  way  out  of  the  difficulty." 

But  the  mere  installation  of  adjustable  furniture  in  a 
schoolroom  means  nothing  of  itself;  indeed,  many  cases 
of  pupils  poorly  fitted  with  seats  and  desks  are  found 
where  rooms  are  thus  furnished.  Every  pupil  must  have 
the  desk  and  chair  adjusted  to  him  carefully  and  changed 
twice  a  year  to  allow  for  growth.  In  consequence,  many 
teachers  object  to  adjustable  furniture  because  of  the 
trouble  it  causes,  and  also  because  of  the  unsightliness  of 
the  varied  heights  of  desks  and  seats  in  the  same  school- 
room. But  these  are  trivial  objections  and  far  out- 
weighed by  the  great  advantages  to  the  child's  proper 


School  Furniture.  51 

growth.  At  the  present  date  school  authorities  who  use 
stationary  furniture  are  certainly  blamable ;  but  far  more 
to  blame  are  the  authorities  who  install  adjustable  furni- 
ture and  then  neglect  its  proper  adjustment  to  the  chil- 
dren. 

There  are  over  one  hundred  and  fifty  different  makes 
of  school  desks  and  seats,  varying  from  the  simple,  un- 
adorned bench  and  box-like  desk  to  some  exceedingly  com- 
plex and  cumbersome  foreign  contrivances.  The  ideal 
chair  and  desk  should  be  adjustable  and  easy  of  manipu- 
lation. Fig.  9  represents  a  model  chair  and  desk  prop- 
erly regulated  to  seat  its  occupant. 

The  distance  is  the  space  that  would  be  found  between 
a  vertical  line  dropped  from  the  rear  edge  of  the  desk  to 
the  floor  (A-B),  and  the  fron*  edge  of  the  seat  at  D, 
which  in  Fig.  9  is  the  space  between  C  and  D. 

This  distance  should  be  a  minus  quantity  when  the  pu- 
pil is  reading  or  writing. 

The  difference  is  the  vertical  distance  measured  from 
the  rear  edge  of  the  pupil's  desk  and  the  upper  surface 
of  the  seat  (Line  A-C).  The  proper  length  of  this  differ- 
ence should  be  equal  to  the  space  between  the  pupil's  el- 
bow and  the  seat  bones  taken  in  a  sitting  posture.  When 
the  pupil  is  too  far  away  from  the  desk,  he  either  bends 
forward  into  an  unnatural  position  or  slides  too  far  for- 
ward on  his  seat  and  occupies  an  unsteady  position. 


FIG.    9. 

Chair  and  desk  illustrating  proper  seating  of  pupil. 


School  Furniture.  53 

The  difference  between  the  height  of  the  seat  and  desk 
should  not  be  such  that  the  shoulders  are  painfully 
screwed  up  in  writing,  nor  on  the  other  hand  should  the 
pupil  be  obliged  to  lean  forward  to  write  or  read.  It  is 
recommended  by  Robson,  an  English  authority,  that  the 
difference  should  equal  the  length  of  forearm  or  about 
one-sixth  the  height  of  the  pupil,  in  which  case  it  will  be 
found  that  the  under  part  of  the  forearm  will  rest  com- 
fortably on  the  desk  top.  The  height  of  the  seat  should 
correspond  to  the  length  of  the  pupil's  leg  from  the  sole 
of  the  foot  to'  the  knee. 

The  seat  of  the  chair  should  be  slightly  hollowed  out 
to  fit  the  body  anatomically  and  should  not  be  so  wide 
as  to  cause  pressure  against  the  legs  when  they  are  in  the 
flexed  position.  The  back  support  of  the  chair  should 
meet  the  child's  body  just  below  the  prominent  portion 
of  the  shoulder  blades. 

A  small  proportion  of  pupils  who  are  either  abnor- 
mally stout  or  thin,  makes  it  desirable  to  have  in  each 
room  a  few  seats  that  may  be  adjusted  horizontally, 
bringing  the  pupil  nearer  to  or  farther  from  the  desk  as 
may  be  desired.  The  desk  should  be  raised  high  enough 
to  relieve  any  possible  pressure  on  the  thighs  and  to  allow 
the  outstretched  forearm  to  rest  comfortably  on  its  sur- 
face without  any  effort  in  bending  forward.  The  chair 
and  desk  to  insure  a  child's  use  of  them  for  any  length 


54         The  Hygiene  of  the  Schoolroom. 

of  time  without  growing  restless,  must  support  the  body 
comfortably  and  without  any  sense  of  constriction. 

Especial  care  should  be  given  to  crippled  children  who 
are  obliged  to  attend  school.  Those  suffering  with  hip 
disease,  or  knee  disease,  where  the  joints  are  diseased 
and  immovable,  should  be  given  a  seat  with  desk  placed 
eight  or  ten  inches  farther  away  than  ordinarily  in  order 
to  allow  a  greater  range  of  motion.  If  one  of  the  lower 
limbs  be  shortened  by  disease,  a  small  hassock  or  block 
should  be  supplied  on  that  side  upon  which  to  rest  the 
shortened  member. 

To  cases  of  curvature  of  the  spine,  which  are  often  met 
with  in  school  life,  it  will  be  more  difficult  to  give  relief  in 
seating.  The  most  that  can  be  utilized  is  a  pad  or  pillow 
of  some  nature  to  rest  the  back. 

Children  with  such  afflictions  should  be  allowed  more 
than  ordinary  privileges  in  moving  about  the  room  and 
should  not  take  part  m  the  calisthenics,  unless  the  exer- 
cise be  especially  prescribed  by  a  physician  or  a  physical 
instructor. 

A  number  of  excellent  makes  of  adjustable  furniture 
combine  simplicity  and  real  merit.  A  measuring  gauge 
with  full  instructions  is  usually  supplied  and  the  measur- 
ing may  be  done  by  the  teacher  and  the  changing  of 
the  seats  by  the  janitor,  according  to  the  data  sup- 
plied to  him.  So  rapidly  do  some  pupils  grow  that  every 


School  Furniture.  55 

teacher  should  know  of  the  importance  of  properly  fitting 
school  furniture,  and  can  easily  see  that  each  child  is 
comfortably  seated.  Changes  may  be  necessary  with  the 
same  pupil  during  the  school  year.  The  following  table, 
carefully  compiled  by  Dr.  Bowditch,  of  Boston,  Mass., 
will  give  an  idea  of  the  pupil's  growth  during  school  life, 
and  wi'll  readily  illustrate  how  a  desk  at  the  beginning  of 
a  school  year  might  be  correct  and  yet  at  the  close  of  the 
same  year  be  disproportionate. 


Total  No.  of 
)bservations 

finches.) 

f 

1 

A 

1 

l 

0 

w 

r 

N 

oo 

8 

to 

ON 
3 

d 

d 

»0 

to 
f*> 

vO 
to 

to 

d 

* 

to 
to 

s 

vC 

Ov 

vO 

HH 

d 

ON 

Tf 

to 
«o 

co 

vd 

o 

10 

to 

M 

ON 

3 

VO 

8 

to 

vO 

vS 

O 
N 

ON 

d 

0 

ft 

^ 

to 

to 

§ 

to 

«o 

M 

vO 

O 

N 
f  1 

VO 

O 
O 

1 

ON 

to 

vO 

vO 

5 

Tf 

CO 

oo 

ON 
>o 

ON 
to 

f 

OO 

ON 

I 

s- 

O 

CO 
ON 

I 

to 

ro 

N 

to 

J 

O 

rt 

s 

CO 

Tf 

co 

to 

vO 

ON 

0 

1 

S 

n 

«0 

«o 

00 

oo 

to 
to 

oo 

vO 

ON 
VO 

CO 

VO 

1 

to 

N 

to 

ON 

3 

to 

w 
f) 

to 

«0 

vo 

9 

M 

CO 

d 

-58 

I 

ON 
vd 

N 
M 

£ 

0 

oo 
vo 

to 

to 

? 

ON 

to 

O 

to 

M 

VO 

o" 

vd 

* 

to 

I 

ON 

2 

ON 

1 

§ 

ON 

ON 

ro 

ON 
10 

S; 

to 

to 

0 
«0 

? 

ON 

00 

O 

oo 
to 

O 

9 

N 

ON 

of 

to 

CO 

CO 
to 

oo 

1 

rf 

Tf 

to 

to 

- 

| 

M 
to 

to 

! 

~\ 

0 
ON 

vo 

Tf 

a 

oo 

Tf 

ON 

1 

vO 

to 

to 

CO 

9 

to 

co 

9 

vO 
ro 

CO 
tO 

S 

«o 

ON 
N 

* 

ON 

VO 

co 

to 

i 

Tf 

! 

Tf 

ON 

co 

VO 

eg 

1 
pq 

1 

(/) 

W 

To 
'S 
EH 

CO 

0 

1 
"o 

0 

0 

.2* 

O 

1 
^ 

"C 

O 

i 

oT 

(A 
| 

0 

c 

h-  1 

en 

"53 

O 

«2  • 

en 
c  • 

.2  ; 

to  ; 

o  • 

J  : 

o  : 

«<H   ^ 

o  >, 

of  Observations  for 
rls  

O 

M 

| 

1 

e 

CHAPTER  VI 
LIGHT 

In  planning  the  location  of  a  school  building,  great  care 
should  be  taken  to  see  that  it  will  be  well  favored  by 
sunlight.  Sites  in  hollows  and  near  tall  adjoining 
structures  should  be  avoided.  In  the  first  place,  no  ob- 
stacle to  the  entrance  of  light  shquld  exist,  outside  the 
building;  and,  secondly,  a  plentiful  supply  should  not  be 
hampered  by  too  few  or  too  small  windows.  A  won- 
derful improvement  in  the  lighting-  of  school  buildings 
has  been  made  in  the  last  quarter  century.  A  number  of 
schoolhouses,  particularly  the  older  ones,  were  found  very 
deficient  in  light,  due  to  the  small,  low  windows.  Fig. 
10  is  a  type  showing  how  little  attention  the  windows  re- 
ceived in  the  construction  of  a  school  building  twenty- 
five  years  ago ;  and  Fig.  1 1  is  a  strong  contrast,  giving  an 
idea  of  a  modern  school  building  plentifully  supplied  with 
windows. 

The  best  light  will  be  had  where  the  longer  axis  of  the 
building  runs  east  and  west  and  the  windows  are  on  the 
north  and  south  sides  only ;  but  where  a  building  contains 


Light.  59 

four  or  more  rooms  on  each  floor,  it  will  be  more  difficult 
to  arrange  for  a  fair  distribution  of  light.  In  such  cases,  the 
corners  of  the  building  should  face  toward  the  cardinal 
points  of  the  compass,  enabling  the  sunlight  to  enter  every 
room  every  day  of  the  year.  Aside  from  its  advantages  as 
regards  light,  a  building  so  placed  as  to  get  a  good  sun 
exposure  will  be  more  easily  heated  and  more  healthful. 
For  the  best  and  most  equal  distribution  of  light,  the 
schoolroom  should  be  long  and  narrow,  requiring  win- 
dows on  but  one  side.  The  desks  should  be  so  placed  that 
the  light  will  not  shine  in  the  pupil's  eyes,  but  come  from 
the  left  and  rear.  The  light  from  the  left  is  best,  because 
it  falls  without  shadows  upon  the  desk.  As  the  great 
majority  of  pupils  are  right-handed,  they  would  be 
annoyed,  when  writing,  by  the  shadows  that  the  light, 
coming  from  the  right,  would  cast  upon  their  work.  Cross 
lights  from  both  right  and  left  are  also  objectionable. 
Light  from  the  front  is  sure  to  dazzle  the  children's  eyes. 
If  the  light  from  the  rear  predominates,  the  pupil's  head 
casts  a  shadow,  and  there  is  the  added  objection  of  the 
teacher's  inconvenience  in  facing  light  from  the  rear.  If 
the  light  from  this  source,  however,  be  indispensable,  the 
teacher  can  change  the  location  of  the  desk  to  the  rear  oi 
the  room,  where  the  same  oversight  of  the  pupils  is  pos- 
sible. Many  teachers  prefer  their  desks  in  this 


FIG.    11. 

Showing  modern  school  building  plentifully  supplied  with  windows. 


Light.  61 

position.  But  for  teacher  and  pupils  alike,  light  from 
the  left  side  is  desirable. 

The  windows  should  be  high,  reaching  almost  to  the 
ceiling,  and  should  cover  an  area  equal  to  at  least  one- 
fifth  of  the  floor  space  of  the  room.  For  instance,  to  de- 
termine whether  sufficient  light  can  be  admitted:  first, 
find  the  floor  space  by  multiplying  the  length  by  the 
breadth  of  the  room;  then  multiply  the  height  of  each 
window  by  the  width,  and  this  product  by  the  number  of 
windows.  The  latter  amount  should  be  at  least  one-fifth 
of  the  area  of  the  floor. 

Robson  (previously  quoted)  contends  that  the  win- 
dow-sills should  be  at  least  five  feet  above  the  floor,  and 
that  the  windows  should  run  very  high,  in  order  that  the 
light  may  descend  on  the  pupil's  work.  This,  however, 
in  the  case  of  an  ordinary  room  of  average  height  (twelve 
or  thirteen  feet),  would  entail  a  sacrifice  of  at  least  a 
foot  of  good  lighting  space,  as  there  is  little  danger  of 
the  light  shining  upwards  into  the  pupils'  eyes  if  the  sill 
of  the  window  is  three  and  one-half  or  four  feet  from  the 
floor. 

In  every  part  of  a  well-lighted  schoolroom  the  pupil 
should  be  able  to  see  to  read  well,  without  an  extra  effort, 
at  the  normal  reading  distance,  which  is  about  fourteen 
inches.  Artificial  illumination  should  never  be  considered 


62         The  Hygiene  of  the  Schoolroom. 

in  a  schoolroom,  except  in  evening  schools,  where  its  use 
is  imperative.  In  such  cases,  the  best  light,  from  a 
hygienic  point  of  view,  is  the  incandescent  lamp  with 
ground  glass  globe.  The  use  of  the  photometer,  which 
measures  the  exact  amount  of  light  in  a  given  room, 
will  show  that  there  are  many  schools  to-day  whose  light 
needs  to  be  greatly  improved.  This  may  be  done  by  en- 
larging the  windows  both  in  breadth  and  length,  and  also 
by  using  reflectors  and  prisms,  to  be  placed  where  the 
light  enters,  which  greatly  increase  the  amount. 

The  most  evil  effect  of  insufficient  light  is  the  defective 
eyesight  now  becoming  so  common  in  school  children. 
It  is  not  necessarily  the  continuity  and  closeness  of  appli- 
cation, but  the  bad  conditions  under  which  the  eye  must 
work  that  are  responsible  for  so  much  eye-strain.  Dr. 
W.  A.  Mowry  cites  a  case  which  well  proves  this  par- 
ticular point : 

"A  school  was  built  wherein  special  pains  were  taken 
with  hygienic  matters,  good  air  and  excellent  light  were 
abundant.  The  two  hundred  and  fifty  boys  were  exam- 
ined upon  entering,  again  in  two  years,  and  lastly  in  two 
years  more.  Almost  without  exception  the  eyesight,  in 
spite  of  the  constant  use,  was  improved,  showing  that  it 
is  possible  to  obtain  the  right  amount  of  light  and  the 
good  effects  following.  The  conditions  bringing  about 


Light.  63 

such  results  were  as  follows :  Light  admitted  from  one 
side  and  that  from  the  left  side  of  the  pupils  as  they  were 
seated.  Window  space  equalled  ten  per  cent,  of  floor 
space.  Windows  long  and  high.  Rooms  were  long  and 
not  wide,  no  pupil  being  seated  farther  than  twenty-seven 
feet  from  the  source  of  light.  No  swivelled  blinds,  ad- 
mitting light  through  the  crevices,  but  a  semi-opaque 
curtain." 

Some  schoolrooms  have  a  fair  amount  of  light  on  dry, 
clear  days,  and  but  very  little  on  cloudy  days.  A  teacher 
in  such  a  room  is  justified  in  seeing  that  too  close  appli- 
cation, as  in  reading,  is  not  required  on  dull  days,  but 
that  exercises  at  the  blackboard  are  substituted. 

Too  much  light,  with  its  blinding  glare,  is  as  harmful 
as  too  little.  When  the  sun  shines  directly  on  the  pupils 
and  their  work,  it  should  be  toned  down  with  a  sliding 
curtain  of  a  light  straw  color.  The  best  curtain  is  the 
one  that  works  on  a  sliding  device,  enabling  it  to  be  ad- 
justed to  any  part  or  space  of  the  window. 

The  walls  of  the  schoolroom  should  be  of  a  light  green 
tint,  as  the  reflected  light  would  then  be  most  easy  upon 
the  eyes. 


CHAPTER  VII 
THE  HYGIENE  OF  THE  EYE 

That  our  power  of  vision  is  degenerating  cannot  be 
gainsaid :  defective  eyesight  is  one  of  the  penalties  we  pay 
for  education.  Savage  nations  have  especially  good  sight 
and  very  little  trouble  with  the  eyes.  Nations  that  follow 
agriculture,  or  whose  work  is  not  of  a  very  fine  grade, 
or  where  the  education  of  the  young  is  limited,  have  far. 
better  eyesight  than  highly  educated  people  whose  work 
is  of  a  more  refined  order.  Germany  is  the  greatest 
sufferer :  one  investigator  says  that  sixty-nine  per  cent. 
of  its  inhabitants  have  defective  vision.  Children  in  the 
country,  where  the  range  of  vision  is  greater  than  in  the 
crowded  cities,  are  not  so  prone  to  eye-troubles  as  city 
children.  But  though  this  degeneracy  is  a  condition  that 
accompanies  advance  in  civilization,  we  should  not  accept 
it  as  inevitably  a  result  of  civilization.  We  should  rather 
let  it  spur  us  on  to  do  all  in  our  power  to  better  the  con- 
ditions that  affect  vision.  In  this  country,  owing  to  the 
enormous  increase  of  defective  eyesight,  the  subject  is 
forcing  itself  upon  the  medical  profession  and  upon  the 


The  Hygiene  of  the  Eye.  65 

laity  as  well.     It  is  a  well-known  fact  that  this  trouble  is 
alsQ^ojaenital.     The  scientific  researches 


of  Dr.  Ely,  of  New  York,  prove  conclusively  that  in  a 
large  number  of  cases  children  are  born  far-sighted. 
Formerly  it  had  been  held  that  the  only  congenital  defect 
found  in  the  new-born  was  near-sightedness;  but  Dr. 
Ely  had  the  opportunity  of  examining  the  eyes  of  a 
number  of  infants,  and  was  surprised  to  find  that  a  large 
majority  came  into  the  world  with  far-sighted  eyes.  In 
most  cases,  the  trouble  would  naturally,  in  time,  grow 
less,  if  only  the  eyes  were  used  with  great  care.  Instead,  i 
we  have  early  and  constant  application  to  books  in  poorj 
surroundings,  and  a  consequent  increase  of  the  difficulty 
before  the  tenth  year  is  reached.  In  Germany,  Dr.  Con- 
rad, investigating  among  school  children,  found  that  n 
per  cent,  were  short-sighted  at  nine  years,  55  per  cent. 
at  eighteen,  and  62  per  cent,  at  twenty-one.  Dr.  Loring, 
an  American  investigator,  found  that  school  life  rapidly 
impaired  vision,  but  not  to  such  a  startling  extent  as  in 
Germany.  According  to  his  figures,  at  nine  years  3.5  per 
cent.,  at  eighteen  20  per  cent.,  and  at  twenty-one  27  per 
cent,  suffer  from  short-sightedness. 

The  farther  one  progresses  in  the  scale  of  educationA 
the  greater  will  be  the  liability  to  injury  of  the  eyes.j 
This  point  is  well  brought  out  by  Dr.  Cohn's  table  : 


66         The  Hygiene  of  the  Schoolroom. 

Schools>  Average  per  cent.  Average  amount 

of  short-sightedness  short-sightedness. 

Country 1.4 1/24 

Primary 6.7 1/23 

Intermediate 10.3 1/22 

Polytechnic J9-7 1/20 

Latin 26.2 1/19 

Universities 59.0 1/12 

Knowing,  then,  that  many  children  have  weak  eyes  long 
before  they  enter  the  schools,  we  should  make  every  effort 
to  guard  the  eyesight  of  pupils  and  to  study  the  conditions 
and  means  of  its  improvement. 

The  strangest  point  brought  out  by  the  writer  through 
an  extensive  examination  of  the  eyes  of  school  children, 
and  adults  as  well,  was  that  although  the  eyes  of  many 
were  seriously  affected,  the  persons  were  apparently 
ignorant  of  the  fact.  The  onset  was  insidious,  and  little 
notice  had  been  taken  until  the  damage  was  irreparable. 
Twelve  pupils  were  found  who  had  practically  no  sight 
in  one  eye,  yet  who  were  all  doing  the  required 
school  work.  The  remaining  good  eye  had  been  saddled 
with  the  work  of  both  and  was  doing  it  as  well  as  pos- 
sible. It  so  happened  that  the  trouble  with  the  eye  was 
in  the  retina  and  the  optic  nerve ;  and  as  the  child  did  not 


The  Hygiene  of  the  Eye.  67 

complain,  and  there  was  nothing  in  the  outward  appear- 
ance of  the  eye  to  draw  attention  to  it,  the  trouble 
passed  unnoticed.  A  number  of  teachers  frankly  ad- 
mitted that  they  had  thought  many  pupils,  who  in  reality 
were  suffering  most  severely  from  defective  vision, 
merely  stupid  and  inattentive. 

The  writer  examined  the  eyes  of  one  thousand  school 
children  in  their  respective  schoolrooms.  The  Snellen 
test  types  were  used,  and  each  eye  tested  separately.  The 
pupils  were  from  eight  to  fifteen  years  of  age,  and  were 
of  all  social  grades.  No  difference  was  noted  between 
the  aptitude  of  poorer,  ill-nourished  children  having  de- 
fective vision  and  that  of  the  children  of  the  well-to-do. 
Very  slight  defects  were  not  noted,  but  all  marked  had 
noticeable  trouble. 

The  results,  to  say  the  least,  were  appalling.  Of  one 
thousand  examined,  334,  or  33.4  per  cent.,  were  defective. 
One  in  every  three  examined  was  doing  work  for  which 
he  was  not  fitted,  was  straining  his  eyes  to  do  that  which 
required  normal  eyes.  No  ailowance  was  being  made  in 
any  case,  as,  in  the  majority  of  instances,  the  teacher  was 
unaware  of  the  difficulty.  The  usual  symptoms  of  eye- 
strain,  such  as  headache,  restless  sleep,  loss  of  appetite, 
twitching  of  the  eye  and  lid  muscles,  are  not  always 
present,  and  nothing  but  periodical  examinations  of  the 


68         The  Hygiene  of  the   Schoolroom. 

eye  will  show  existing  defects.  Often,  too,  many  pupils, 
from  a  natural  reticence,  will  not  complain,  although 
suffering. 

The  following  tables  show  the  results  in  detail: 

ONE   THOUSAND    CASES    EXAMINED. 

Both  eyes  defective 146 

Left  eye  only 1 24 

Right  eye  only 52 

Entire  absence  of  sight  in  one  eye 12 

Number  of  cases  of  strabismus,  or  squint 28 

Those  defective  using  glasses  to  correct  vision 16 

Not  using  glasses 318 

Granular  lids 4 

Corneal  scars 2 

VISION    AND    HEARING   TESTS    IN    PUBLIC    SCHOOLS. 

(GULICK  AND  AYRES.) 

r,.^.  NUMBER     DEFECTIVE    PER 

LlB«        EXAMINED.     VISION.     CENT 

Bayonne,  N.  J 4,610  353  7.7 

Camden,  N.  J 1906  10,028  2,757  27.7 

Cleveland 1900  30,045  6,221  20.7 

Cleveland,  well-to-do  district 1907  668  216  32.4 

Cleveland,  congested  district 1907  616  437  71.7 

Dunfermline 1907  1*526  255  17.0 

Edinburgh 1904  1,330  574  43.2 

Massachusetts 1907  402,937  99,609  22.3 

Counties  of  Mass,  except  Suffolk ....    1907  ....  ....  19.9 

Suffolk    County    (Boston,    Chelsea, 

Revere,  Winthrop) ".  . .    1907             30.7 

Milwaukee 1907  1,960  293  14.9 

Minneapolis 25,696  8,166  30.0 

Minneapolis 1908  710  170  23.9 

New  York  City 1906  79.065  24,534  31.3 

Pawtucket,  R.  1 1901  4.663  517  n.i 

Utica,  N.  Y 1897  6,113  667  10.9 

Worcester,  Mass 1 1,953  2,281  19.1 


The   Hygiene  of  the  Eye. 


69 


It  is  little  less  than  criminal  that  conditions  are  allowed 
to  exist  resulting  in  such  wholesale  havoc  with  the  chil- 
dren's eyes.  Our  first  great  duty  is  a  realization  of  the 
situation,  a  survey  of  the  probable  offending  causes,  and 
an  earnest  attempt  at  their  betterment. 

If  we  could  understand  the  beautiful  and  delicate 
mechanism  of  the  human  eye,  we  might  take  greater  pains 
to  preserve  its  usefulness.  Nature  has  wisely  foreseen 
the  delicacy  of  the  eye,  the  great  care  required  for  its 
well-being,  and  the  necessity  of  guarding  it  better  than 
the  organ  of  any  of  the  other  special  senses.  It  is  set  into 
and  protected  by  the  bony  orbital  cavity.  In  front  it  is 
protected  by  two  curtains,  the  eyelids. 

The  eyeball,  on  account  of  its  almost  incompressible 
nature,  cannot  be  drawn  into  the  socket,  but  simply 


,<Sc/erotif 


Cornea 


Pupil 


FIG.    12. 


70         The  Hygiene  of  the  Schoolroom. 

rotates  there,  being  drawn  to  either  side,  up- 
wards or  downwards,  by  small  muscles  attached  to  the 
contiguous  bony  structures.  When  the  adjustment  of 
the  muscles  is  perfect,  a  person  is  able  to  draw  the  eye 
to  one  side,  but  the  corresponding  muscle  having  an  equal 
power,  the  equilibrium  of  the  eyeball  is  maintained.  In 
consequence  of  children's  diseases,  sometimes  one  of 
the  small  muscles  becomes  paralyzed.  This  muscle  is  no 
longer  able  to  do  its  allotted  work  of  helping  to  hold  the 
eye  in  position,  and  the  eyeball  is  pulled  to  the  opposite 
side  by  the  unaffected  muscle.  This  condition  is  known 
as  strabismus,  or  squint,  and  often  follows  early  cases  of 
long-  or  short-sightedness. 

These  cases,  as  soon  as  noticed  by  the  teacher,  should 
be  brought  to  the  parents'  attention,  with  a  request  that 
an  attempt  be  made  to  remedy  the  defect.  Very  good 
Jresults  are  often  secured  by  the  wearing  of  carefully  se- 
[lected  glasses  upon  an  oculist's  advice.  Undoubtedly  the 
parent  will  notice  the  squint  as  soon  as  the  teacher,  but 
the  request  of  the  latter  to  have  something  done  will 
usually  produce  good  results.  Sometimes,  however,  it 
will  be  difficult  to  impress  an  ignorant  person  with  need 
for  action  in  such  cases.  One  mother  who  was  re- 
minded of  her  duty  in  a  neglected  case,  thought  she  would 
be  "flying  in  the  face  of  Providence."  She  was  finally 


The  Hygiene  of  the  Eye.  71 

convinced,  nevertheless,  of  her  error  in  the  matter,  and 
the  case  was  referred  to  an  oculist,  with  great  benefit. 
With  some  long-standing  cases,  glasses  will  not  mend 
matters,  and  an  operation  will  be  necessary.  This  opera- 
tion is  simple,  however,  and  usually  successful.  Indeed 
oculists  are  compelled  to  operate  in  fewer  cases  of  this 
kind  each  year,  as  they  are  now  becoming  more  adept  at 
removing  the  difficulty  without  recourse  to  an  operation. 

When  an  eye  turns  in  or  out  or  away  from  its  fellow, 
the  danger  is  that  the  power  of  sight  will  begin  to  fail  in 
the  eye  and  will  continue  to  fail.  Every  case  of  squint 
discovered,  then,  should  be  referred  to  the  eye  specialist. 

In  studying  the  eye  as  shown  in  Fig.  12  from  the  front 
to  the  back,  we  see  the  cornea,  the  aqueous  humor,  the 
pupil,  the  iris,  the  crystalline  lens,  the  vitreous  humor,  and 
the  retina.  The  cornea,  perfectly  transparent,  is  the  first 
structure  through  which  the  light  passes.  The  aqueous 
humor  fills  the  space  between  the  back  of  the  cornea  and 
the  lens.  The  iris  divides  this  space  into  two  chambers, 
the  anterior  and  the  posterior.  The  colorless,  transparent, 
bi-convex,  crystalline  lens  serves  to  focus  the  light  enter- 
ing the  eye.  The  vitreous  humor  is  a  soft,  jelly-like  sub- 
stance, clear  and  transparent.  The  retina  is  the  innermost 
lining  of  the  eyeball,  and  is  the  sensitive  area  upon  which 
the  images  from  external  objects  are  refracted. 


72         The  Hygiene  of  the  Schoolroom, 


FIG.   13. 

SHOWS  THE  MUSCLES  OF  THE  EYEBALL  IN  NORMAL  POSITION. 

A,  A.  The  parallel  optic  axes.  C,  C.  The  centres  of  motion  of  the 
globes.  B,  B,  Axes  of  rotation  of  the  oblique  muscles.  D,  D.  Axes 
01  rotation  of  the  superior  and  inferior  muscles.  «,  n.  External 
straight  muscles.  *',  /'.  Internal  straight  muscles.  o,  o.  Superior 
oblique  muscles,  running  through  pulleys  at  Z>,  D.  s.  Superior  straight 
muscle  of  one  eye.  This  muscle  is  removed  in  the  other  eye  to  show 
the  optic  nerve,  m,  m.  Attachments  of  the  inferior  oblique  muscles, 
which  cannot  be  seen  in  this  view  from  above.  The  space  between 
Z>,  Z>,  is  the  cavity  of  the  nose. 


If  we  look  at  a  house  a  mile  distant  and  then  look  at 
one  of  the  fingers  placed  before  the  eyes,  we  find  it  can 
only  be  done  with  a  distinct  sense  of  muscular  effort 
somewhere  in  the  eye.  This  effort,  spoken  of  as  accommo- 
dation, is  the  same  act  as  is  accomplished  by  the  screw  in 


The  Hygiene  of  the  Eye.  73 


FIG.   14. 


FIG     15. 


FIG.  16. 


74         The   Hygiene  of  the  Schoolroom. 

an  opera-glass.  It  is  performed  by  the  aid  of  ciliary  mus- 
cles and  the  suspensory  ligament  of  the  lens,  which  alter 
the  convexity  of  the  lens.  Emmetropia  is  a  term  used  to 
designate  normal  vision  as  illustrated  by  Fig.  14,  when 
parallel  rays  entering  th'e  eye  are  focused  exactly  upon 
the  retina.  But  in  some  eyes  the  eyeball  is  too  long,  and 
the  parallel  rays  meet  in  front  of  the  retina,  as  shown  in 
Fig.  15.  This  condition  is  known  as  myopia,  or  short- 
sightedness. To  enable  such  eyes  to  see  distant  objects 
it  is  necessary  to  use  concave  glasses.  Or  the  eyeball 
may  be  too  short ;  then  the  parallel  rays  come  to  a  focus 
behind  the  retina,  as  in  Fig.  16.  This  condition  is  called 
hypermetropia.  or  long-sightedness,  and  for  its  correction 
cojivex  glpgsp*  are  needed.  In  yet  other  cases,  owing  to 
the  fact  that  the  cornea  or  the  crystalline  lens  is  not  true 
in  shape,  the  rays  are  not  focused  at  any  single  point  upon 
the  retina.  This  is  spoken  of  as  a^io-mal^m,,  and  is 
usually  corrected  by  cylindrical  glasses. 

These  are  the  principal  defects  that  are  found  in  chil- 
dren's eyes,  and  though  the  teacher  is  not  expected  to 
be  able  to  differentiate  them,  she  should  make  it  her  duty 
to  report  all  cases  to  the  proper  authorities.  In  cities  or 
towns  where  a  medical  inspector  is  employed  in  the 
schools,  a  great  burden  of  responsibility  is  lifted  from  the 
teacher's  shoulders.  If  there  should  be  no  such  officer, 


The  Hygiene  of  the  Eye.  75 

the  teacher  can  easily  learn  to  discover  at  least  the  most 
flagrant  cases  of  defective  vision. 

The  type  as  printed  on  the  plate  opposite  can  be  used 
in  examining  the  eyes,  or  for  a  small  sum  the  regular 
Sneller  test  types  may  be  purchased  and  hung  in 
the  room.  The  record  should  be  kept  as  fol- 
lows :  R.  V.  is  the  abbreviated  form  of  writing  "right 
vision" ;  L.  V.  "left  vision."  Seat  the  pupil  twenty  feet 
from  the  test  types,  and,  if  examining  the  right  eye,  place 
a  piece  of  cardboard  before  the  left  eye.  If  the  five  rows 
of  type  can  be  read  entire,  vision  is  normal,  or 
R.  V. =2 0/20.  If,  however,  only  the  four  upper  rows  are 
read,  and  tlu  thirty-feet  type  are  the  smallest  discernible, 
the  vision  would  be  20/30.  If  only  the  upper  row  can 
be  read,  the  vision  would  be  but  20/60.  Proceed  in  the 
same  manner  with  the  left  eye,  and  use  the  same  means  of 
recording  the  degree  of  vision.  For  a  reading  test,  the 
normal  eye  should  be  able  to  make  out  the  following  dia- 
mond type  at  a  distance  of  twelve  inches : 

THE  FACULTY  of  memory,  which  receives  and  retains 
ideas  and  images,  and  which  exhibits  them  again 
'  with  or  without  the  exercise  of  volition,  early  be- 
came the  subject  of  philosophical  research.  There 
are  very  many  curious  phenomena  connected  with 
this  power  of  the  mind  ;  it  is  sometimes  as  recreant 
to  its  trust,  when  most  its  service  may  be  required, 
as  the  veriest  bankrupt;  at  other  times,  when  in  a 
fit  of  strange  caprice,  it  will  obtrude  upon  us  in  a 
most  unwelcome  and  unceremonious  manner,  heap- 
ing upon  us  thoughts  and  things  we  would  willin  Ij 
bury  in  oblivion.  Yet,  after  all,  memory  ia  icdid- 
penaable  to  moral  economy ;  its  aid  is  aa  much  re- 
quired  m  things  mean  as  in  things  immense.  Without 
this  mysterious  private  secretary,  we  could  not  enact 
our  several  parts  on  the  arena  of  life  ;  our  boasted 
being  would  be  reduced  to  a  mere  vegetable  exist- 
ence. Memory  is  said  to  be  essential  to  every  kind 
of  action;  timid  animals  are  instigated  to  avoid 
capture,  and  to  flee  from  the  attacks  of  the  very 
ferocious,  more  from  the  remembrance  of  the  conse- 
quences of  previous  sufferings  than  from  what  we 

FIG.    17* 


76         The  Hygiene  of  the  Schoolroom. 

In  1895,  Dr.  Frank  Allport,  of  Chicago,  devised  a  set 
of  practical  questions  for  instructing  teachers  how  to  ex- 
amine pupils  above  the  first  grade  for  the  detection  of 
eye  and  ear  defects.  These  are :  i.  Does  the  pupil  ha- 
bitually suffer  from  inflamed  lids  or  eyes?  2.  Does  the 
pupil  fail  to  read  a  majority  of  the  letters  in  the  number 
XX  (20)  line  of  the  Snellen  test  types,  with  either  eye? 
3.  Do  the  eyes  and  head  habitually  grow  weary  and 
painful  after  study?  4.  Does  the  pupil  appear  to  be 
"cross-eyed"?  5.  Does  the  pupil  complain  of  earache 
in  either  ear?  6.  Does  matter  (pus)  or  a  foul  odor 
proceed  from  either  ear  ?  7.  Does  the  pupil  fail  to  hear 
an  ordinary  voice  at  twenty  feet  in  a  quiet  room?  Each 
ear  should  be  tested  by  having  the  pupil  hold  his  hand 
over  first  one  ear  and  then  the  other.  The  pupil  should 
close  his  eyes  during  the  test.  8.  Is  the  pupil  frequently 
subject  to  "colds  in  the  head"  and  discharge  from  the 
nose  and  throat?  9.  Is  the  pupil  a  habitual  "mouth 
breather"? 

If  an  affirmative  answer  is  found  to  any  of  these  ques- 
tions the  pupil  is  given  a  printed  card  of  warning  to  be 
handed  to  the  parent.  These  cards  are  non-obligatory 
in  their  nature.  They  do  not  require  anything  of  the 
parent,  who  is  at  perfect  liberty  to  take  notice  of  the 
warning  card  or  not,  as  he  sees  fit.  If  the  parent  neg- 
lects the  warning  it  is  repeated. 


The  Hygiene  of  the  Eye.  77 

With  children  who  are  not  yet  familiar  with  the  alpha- 
bet the  tests  previously  given  (p.  74)  are  useless.  For 
such  Dr.  Cohn  suggests  the  use  of  a  line  of  capital  E's, 
the  child  to  determine,  at  a  distance  of  twenty  leet,  the 
direction  in  which  the  arms  of  the  letter  point,  whether 
upwards,  downwards,  to  right,  or  to  left. 

t 

m  E  3  in  m 

FIG.    18. 

To  examine  for  astigmatism  is  far  more  difficult  than 
to  examine  for  hypermetropia  or  myopia.  For  such  an 
examination  the  horizontal  and  vertical  lines  of  Fig.  19 
may  be  used.  Test  one  eye  at  a  time,  r.t  a  distance  of 
twenty  feet.  If  astigmatism  is  present,  some  of  the  lines 
will  be  blurred  and  run  together,  while  the  others  will  be 
clear  and  well-defined. 

A  peculiar  anomaly  in  some  persons — most  commonly 
men — is  a  failure  to  distinguish  colors.  This  defect, 
known  as  color-blindness,  is  theoretically  explained  as 
being  caused  by  the  absence  of  one  or  more  of  the  color 
sensations.  To  detect  it,  a  heap  of  worsted  yarn  of  all 
tints  is  taken,  and  a  thread  of  a  particular  color,  for  in- 
stance a  red,  is  selected.  The  subject  is  then  required  to 


78         The  Hygiene  of  the  Schoolroom. 


FIG.  19. 

TEST  FOR  EXAMINING  THE  EYES  FOR  ASTIGMATISM. 

pick  out  from  the  heap  A.11  of  the  other  threads  of  the 
same  color ;  if  red-blind,  he  will  choose  not  only  the  reds 
but  the  greens.  It  is  often  a  matter  of  consequence  to 
discover  this  peculiarity,  especially  in  railroad  men  and 


The  Hygiene  of  the  Eye.  79 

sailors,  since  the  colors  most  often  mistaken  are  red  and 
green,  the  important  colors  in  railroad  and  marine  signals. 
The  teacher  should  constantly  watch  the  pupils  for  in- 
flamed eyes,  inflamed  eyelids,  styes  and  squints.  She 
should  pay  particular  attention  to  those  that  hold  the  read- 
ing book  less  than  twelve  inches  from  the  eyes,  or  at  arm's 
length,  to  those  that  tilt  their  heads  when  reading,  those 
that  cannot  read  blackboard  writing  from  their  seats, 
those  that  complain  habitually  of  headache  and  those 
that  fear  the  light.  The  parent  should  be  notified  of 
the  condition  of  the  child's  eyes  and  encouraged  to  have 
the  proper  glasses  made  and  worn.  Children  with  defect- 
ive vision  should  be  looked  upon  as  physically  below 
the  standard  and  should  not  be  expected  to  do  full  work. 

It  should  be  the  duty  of  school  authorities  to  study  well 
every  condition  that  would  better  the  pupil's  vision. 
The  greatest  essential  is  good  light:  schools  with  poor 
light  show  a  high  percentage  of  defectiveness,  one  case, 
where  the  light  was  miserable,  running  as  high  as  fifty- 
nine  per  cent.  The  use  of  slate  and  pencil  is  far  more 
harmful  to  the  eyes  than  paper  and  pencil.  The  paper  on 
which  the  books  are  printed  should  be  heavy  and  without 
gloss. 

The  type  used,  according  to  Dr.  Cohn  of  Breslau,  who 
is  an  authority  on  the  optical  requirements  of  good  printing, 


80        The  Hygiene  of  the  Schoolroom. 

should  not  be  less  than  1.50  mm.  in  height  and  the  small 
"  n  "  not  less  than  1.30  mm.  wide. 

For  the  beginners  in  reading,  the  type  should  be  5  mm.  in 
height,  and  gradually  reduced  to  2  mm.  in  height  by  the  time 
the  fifth  year  of  school  work  is  completed.  The  distance 
between  letters  of  the  same  word  should  measure  .75  mm. 
and  between  the  separate  words  2  mm.,  with  2.5  mm.  to 
3  mm.  between  the  lines. 

The  eye  is  much  more  easily  fatigued  in  reading  long  lines 
than  short  ones,  and  it  is  recommended  that  the  length  of 
lines  of  the  school  book  approximate  80  to  90  mm.  and  be 
not  longer  than  100  mm. 

It  is  essential  that  the  type  employed  in  books  used  in 
the  first  grade  be  large  and  distinct,  for  now  for  the  first 
time  the  vision  of  the  child  is  to  be  confined  to  a  limited 
space. 

We  must  use  two  hands  to  do 
most  of  these  things. 

FIG.  20. 

The  second  year,  the  eye  having  become  habituated  to  the 
books,  the  type  need  not  be  so  large. 

It    does    not    hurt    the    eyes   to    use    them. 


The  Hygiene  of  the  Eye.  81 

Indeed,  they  learn  to  see  better  by  being 
used,  if  only  they  are  well  treated. 

FIG.   21. 

But  in  no  books  supplied  for  the  schools  should  the  type  be 
less  in  size  than  "Small  Pica,"  which  is  the  type  employed 
in  this  book. 

These  matters,  however,  may  be  all  changed  to  the 
desirable  point,  and  yet  many  eyes  continue  to  suffer. 
There  is  a  radical  fault  in  the  school  system,  and  that  is 
in  the  school  programme :  It  should  be  changed  so  that 
the  periods  of  eye-work  would  be  shortened  and  greater 
time  left  between.  It  is  a  difficult  problem  to  solve,  con- 
sidering the  ambition  of  the  child,  of  the  parent,  and  of 
the  school  authority,  but  the  time  must  come  for  a  wide 
departure  from  the  present  mode  of  work.  The  course 
of  study  should  be  less  compulsory — rather  elective  to 
suit  each  individual  case,  and  the  amount  of  work  ex- 
pected from  each  child  should  be  a  matter  for  the  physi- 
cian to  determine  after  a  careful  consideration  of  motor 
and  mental  ability. 

Care  should  be  taken  about  the  "extras"  imposed  upon 
a  child,  such  as  private  lessons  in  music,  drawing,  and 
fancy  needlework,  as  often  such  work  is  especially 
fatiguing  to  the  child's  eyes.  The  home  study  should  be 
entirely  omitted  where  the  pupil  has  weak  eyes. 


CHAPTER  VIII 
THE  HYGIENE  OF  THE  EAR 

Next  in  importance  to  the  eye  in  the  consideration  and 
care  that  it  requires  is  the  ear.  The  percentage  of  aural 
defectiveness  in  school  children  ranges  with  different  ob- 
servers from  six  to  twenty  per  cent.  Careful  examination 
of  the  hearing  of  a  large  number  of  school  children  in 
Chicago  showed  that  16  per  cent,  had  perceptible  defect 
in  one  ear,  and  that  7  per  cent,  had  defects  in  both  ears. 
Children  of  the  age  of  seven  or  eight  years  were  more 
prone  to  show  such  defects  than  those  of  any  other  age. 
School  conditions,  however,  will  not  benefit  or  harm  the 
ear  in  as  great  a  degree  as  the  eye. 

The  causes  of  deafness  will  be  clearer  with  an  under- 
standing of  the  anatomy  of  the  ear.  It  consists  of  three 
portions :  the  external,  the  middle,  and  the  internal.  The 
external  ear  comprises,  in  addition  to  the  part  seen  on  the 
exterior  of  the  head,  the  passage  that  leads  inward  as  far 
as  the  drum-head.  The  middle  portion,  or  tympanum, 
is  a  cavity  lying  beyond  the  drumhead.  From  this  part 
a  small  tube  leads  to  the  upper  portion  of  the  throat,  or, 


The  Hygiene  of  the  Ear.  83 

more  properly  speaking,  the  pharynx;  this  is  called  the 
Eustachian  tube.  Its  object  is  to  equalize  the  pressure 
of  air  on  each  side  of  the  drum,  allowing  it  to  move  with 
the  slightest  air  vibration.  In  the  tympanum  lie  three 
small  bones,  forming  a  connection  between  the  drum- 
head and  the  internal  ear.  The  internal  ear  consists  of 
chambers  and  tubes  hollowed  out  of  the  temporal  bone. 

P 


FIG.  22. 

VIEW   OF   THE    HUMAN    EAR. 

A,  external  auditory  meatus;  B,  utricle;  C,  saccule;  Z>,  semi-circular 
canal;  E,  nerve;  F,  cochlea;  G,  Eustachian  tube;  H,  tympanic 
membrane ;  f,  cochlea. 

In  1907,  of  402,937  children  examined  in  Massa- 
chusetts for  defective  hearing,  27,387  or  6.3  per  cent, 
were  found  to  be  suffering  from  some  degree  of  deaf- 
ness. In  New  York  in  1906,  of  79,065  examined, 
1,633  showed  defective  hearing. 


84         The  Hygiene  of  the  Schoolroom. 

Some  points  should  always  be  borne  in  mind.  Blows 
on  the  ear  are  extremely  likely,  by  forcible  compression  of 
the  air  in  the  auditory  canal,  to  rupture  the  drumhead. 
Even  where  corporal  punishment  is  tolerated,  this  should 
not  be  the  method  employed.  Pulling  the  ear  will  some- 
times cause  it  to  ache.  At  any  rate,  if  a  child  be  slapped 
upon  the  ear,  or  be  pulled  by  the  ear  by  a  teacher,  the 
parent  will  use  that  as  an  attributable  cause  for  any  dis- 
turbance that  may  at  any  later  time  arise.  Foreign 
bodies  in  the  ear,  such  as  peas,  beans,  and  small  pebbles, 
should  be  let  severely  alone,  as  any  probing  will  usually 
push  the  substance  farther  into  the  canal.  They  can 
safely  be  removed  only  by  washing  out  with  an  ear 
syringe.  There  is  excellent  sense  in  the  old  adage, 
"Never  put  anything  into  your  ear  smaller  than  your 
elbow,"  which  is  a  facetious  way  of  advising  putting 
nothing  at  all  into  the  ear.  Teachers  should  warn  pupils 
against  the  very  dangerous  practice  of  introducing  pen- 
holders, pencils  and  pens  into  their  ears. 

A  recent  invention  called  the  audiometer  has  been  con- 
siderably used  in  testing  hearing  and  is  valuable  from  its 
simplicity  of  operation  and  the  exactness  of  its  working. 
It  employs  an  electric  current  which  can  be  varied  at  will 
through  a  fixed  scale  of  intensities,  the  operation  produc- 
ing a  series  of  clicks  in  a  telephone  receiver  held  to  the 


The   Hygiene  of  the  Ear.  85 

ear.  When  this  instrument  is  not  available,  the  most 
satisfactory  way  of  determining  the  extent  of  a  child's 
hearing  is  by  the  "whispered  number"  test :  a  normal  ear 
should  hear  the  whispered  voice  at  twenty  feet.  Seat 
the  pupil  twenty  feet  away,  with  one  ear  towards  the 
person  making  the  test,  and  the  other  ear  blocked  by  the 
hand.  Be  careful  to  note  that  the  child  is  not  looking  at 
the  examiner,  as  it  would  be  difficult  to  tell  how  much 
was  understood  by  the  ears,  and  how  much  by  sight-read- 
ing of  the  lips.  Whisper  any  number  at  random  and  ask 
the  child  to  repeat,  giving  at  least  ten  numbers.  If  the 
child  is  unable  to  hear,  or  wrong  answers  are  given, 
advance  slowly  toward  the  pupil,  repeating  the  number 
in  the  same  manner.  Make  careful  record  of  the  hearing, 
marking  it  normal  if  the  whisper  is  heard  at  twenty  feet, 
one-half  if  heard  at  only  ten  feet,  one-quarter  if  at  five 
feet,  etc.  The  test  should  of  choice  be  conducted  quietly 
and  away  from  the  remainder  of  the  pupils.  Sometimes 
the  ticking  of  a  watch  is  used  in  place  of  the  voice ;  but 
the  number  test  is  preferable,  since  many  pupils,  from  a 
desire  to  be  considered  "smart,"  will  profess  to  continue 
to  hear  the  watch  long  after  they  are  unable  to  do  so. 
The  ticking  of  an  ordinary  watch  should  be  heard  by  the 
normal  ear,  in  a  quiet  room,  at  a  distance  of  twenty  feet. 
The  school,  as  has  been  remarked,  is  hardly  as  account- 


86         The  Hygiene  of  the  Schoolroom. 

able  for  bad  hearing  as  for  bad  eyesight.  Many  of  the 
ear  troubles  follow  infectious  diseases;  some  result  from 
colds,  enlarged  tonsils,  chronic  catarrh,  and  adenoid 
vegetations;  while  others  are  mechanical  in  their  nature 
and  are  the  result  of  some  foreign  body  in  the  external 
ear  passages,  most  often  a  plug  of  hardened  wax.  When 
from  the  latter  source,  the  trouble  can  easily  be  remedied 
by  a  surgeon.  Bad  hearing  from  catarrh  is  an  exceed- 
ingly difficult  matter  to  treat,  but  the  only  time  that  any 
prospect  of  improvement  can  be  held  out  is  during  the 
school  age,  for  usually  after  this  stage  the  case  becomes 
incurable. 

Deafness  due  to  enlarged  tonsils  and  adenoid  growths 
in  the  naso-pharynx  is  greatly  improved  when  an  opera- 
tion is  performed.  When  due  to  the  above  causes,  a 
defect  in  speech  is  usual  and  the  child  breathes  with  the 
mouth  half-opened.  This  condition  is  known  as  mouth- 
breathing.  The  child  presents  a  distracted,  expressionless 
appearance,  is  unable  to  talk  well,  to  hear  well,  or  to  study 
well;  unable  to  talk  well,  because  the  enlarged  growths 
in  the  throat  act  as  foreign  bodies;  unable  to  hear  well, 
because  these  same  growths  block  up  the  Eustachian  tube, 
spoken  of  as  running  from  the  throat  to  the  ear;  and 
unable  to  study,  because  the  nose  and  the  throat  are  partly 
occluded,  denying  a  sufficient  amount  of  air  to  the  lungs, 


The  Hygiene  of  the  Ear.  87 

and  causing  the  same  sleepy,  tired  feeling  that  poor  ven- 
tilation produces.  Adenoids  are  believed  to  be  very  fa- 
vorable soil  for  the  growth  of  the  tubercle  bacillus  and 
are  often  starting  points  of  diphtheria  and  scarlet  fever. 

In  1907,  in  New  York  city,  of  7,608  pupils  examined, 
2,159  suffered  from  enlarged  tonsils  and  1,248  with 
adenoid  growths. 

A  child  with  enlarged  tonsils  or  adenoid  growths 
speaks  always  as  one  does  with  a  severe  cold  in  the  head. 
He  says  "cobbod"  for  "common,"  and  "sig"  for  "sing." 

The  photographs  Nos.  23  and  24  show  a  child  with  the 
typical  face  of  a  mouth-breather  from  adenoids  and  the 
change  in  the  entire  facial  appearance  when  the  offend- 
ing growths  have  been  removed. 

It  would  be  valuable  for  every  teacher  to  have  a 
register  kept  containing  data  of  each  pupil's  eye  and 
ear  capacity.  With  this  knowledge  at  hand,  many  who 
are  considered  stupid  would  be  shown  to  be  only  unfor- 
tunate, inasmuch  as  the  avenues  to  their  brain  are  partly 
blockaded;  they  need  additional  aid  instead  of  censure. 
Those  whose  hearing  is  defective  should  be  given  seats 
within  easy  range  of  the  teacher's  voice,  and  should  at  all 
times  be  subjects  for  special  consideration  and  regard. 


FIG.   23. 


FIG      24. 


CHAPTER  IX 
THE  VOCAL  ORGANS 

The  voice  is  the  <;ound  resulting  from  the  passing  in 
and  out  of  the  air  over  the  vocal  cords,  two  folds  of 
membrane  in  the  larynx,  or  upper  part  of  the  air  passage 
between  the  windpipe  (trachea)  and  the  base  of  the 
tongue.  When  the  cords  are  relaxed,  the  air  passes  be- 
tween them  without  sound ;  but  at  will  the  small  muscles 
guiding  the  cords  can  be  set  tighter,  so  that  as  the  air 
passes  they  vibrate  and  produce  sound.  The  difference 
in  pitch  is  created  by  the  degree  of  tension  of  these  cords ; 
when  they  are  loosely  set,  a  low  note  results ;  when 
tighter,  a  high  one.  With  the  assistance  of  the  upper 
part  of  the  throat  (the  pharynx),  the  cavity  of  the  mouth, 
the  tongue  and  the  lips,  these  sounds  are  modified  into 
spoken  words. 

A  good  voice  and  the  ability  to  speak  clearly  and  dis- 
tinctly are  of  such  incomparable  value  in  after  life  that 
especial  effort  should  be  made  by  teachers  in  training  the 
voice.  With  the  advent  of  the  Kindergarten,  where  the 
child  comes  earlier  than  formerly  under  school  training, 


The  Vocal  Organs. 


teniid.  carl  ? 


FIG.  25. 
THE   LARYNX   AND    ADJACENT    PARTS,    SEEN    FROM    ABOVE. 

and  with  the  knowledge  that  the  teacher  should  possess 
of  the  great  improvement  persistent  effort  and  patience 
will  bring  about  in  the  speech  of  children,  the  coming 
generation  should  show  decidedly  less  defectiveness  of 
this  kind. 

The  child  is  able  to  talk  fairly  well  by  the  time  he 
reaches  the  school,  having  begun  usually  at  from  twelve 
to  twenty  months.  Any  child  at  two  years  of  age  who  is 
not  able  to  talk  should  be  a  subject  for  the  physician  to 
consider. 


92         The  Hygiene  of  the  Schoolroom. 

The  principal  vocal  defects  noted  are  stuttering,  stam- 
mering, lisping,  drawling,  hurried  speech,  thick  and  in- 
distinct speech.  Many  of  these  affections  are  inherited, 
and  usually  manifest  themselves  when  the  child  is  from 
three  to  seven  years  of  age.  Careful  observers  have 
noted  that  errors  of  speech  are  intensified  at  about  the 
ages  of  second  dentition  (six  to  eight  years)  and  of 
puberty  (about  fourteen  years). 

Stuttering  and  stammering  are  commonly,  but  im- 
properly, used  as  synonymous.  Stuttering  is  defined 
by  Dr.  H.  Gutzman  as  a  spasmodic  nervous  disorder 
which  obstructs  the  uttering  of  syllables  by  spastic  con- 
tractions at  the  stop  points  for  vowels  and  consonants  in 
the  articulating  tube.  The  impeded  utterance  is  accom- 
panied by  a  spasm,  usually  of  the  muscles  of  the  face  and 
neck,  but  sometimes  involving  the  muscles  of  the  trunk 
and  limbs,  and  is  always  further  accompanied  by  great 
nervous  embarrassment.  The  difficulty  is  encountered 
principally  with  the  explosive  consonants  b,  p,  t,  g  (hard) 
and  k ;  less  often  with  the  other  sounds.  The  impediment 
may  be  complete  (as  "bb — oy"  for  "boy"),  or  incomplete 
("b-b-b— oy"). 

A  stammerer  finds  difficulty  in  articulating  at  all,  and 
succeeds  only  after  repeated  attempts,  while  the  stutterer 
is  able  to  make  sounds,  but  has  trouble  with  syllabic  com- 


The  Vocal  Organs.  93 

binations.  Either  trouble  may  be  of  central  origin — that 
is,  resulting  from  some  disturbance  of  the  speech  center 
in  the  brain — or  of  peripheral  origin  consequent  upon 
some  defect  of  the  respiratory  passages. 

Dr.  Hartwell,  in  examining  one  hundred  and  thirty 
thousand  school  children  in  Boston,  found  that  one  thou- 
sand of  this  number  were  stutterers,  and  that  the  pro- 
portion of  boys  to  girls  suffering  was  as  three  to  one. 

Professor  A.  Melville  Bell,  who  long  studied  this  ques- 
tion, wrote  as  follows :  "No  part  of  education  is,  in  gen- 
eral, so  lightly  esteemed  as  that  of  first  learning  to  speak 
and  read;  yet,  rightly  considered,  there  is  none  of  more 
importance.  The  first  governess,  tutor,  or  schoolmaster 
should  be  a  model  of  distinctness  in  his  own  practice,  and 
should  be  also  intimately  acquainted  with  the  physiology 
of  articulation,  that  he  may,  both  by  wise  precept  and 
potent  example,  mold  the  plastic  mouth  to  grace  and  give 
easy  play  to  the  delicate  machinery  of  speech.  With 
proper  initiatory  training  and  school  surveillance,  stam- 
mering and  its  train  of  silent  errors  would  be  altogether 
unknown." 

Enlarged  tonsils,  adenoid  vegetatisms,  harelip,  cleft 
palate  and  short  tongue-strings  are  all  exciting  causes  of 
impeded  utterance.  Hysteria  and  imitation  are  probably 
causes  in  some  cases,  and  nervousness  is  certainly  a  great 


94         The  Hygiene  of  the  Schoolroom. 

excitant  in  all  cases.  One  pupil,  it  was  noticed,  could 
read  very  well  when  his  back  was  turned  on  teacher  and 
pupils.  Dr.  Pershing,  of  Denver,  declares  that  when 
alone  or  in  darkness  the  stuttering  or  stammering  habit 
disappears  entirely,  and  it  is  a  matter  of  common  observa- 
tion that  undue  excitement  or  embarrassment  intensifies 
the  defect. 

The  treatment  of  such  cases  must  first  be  referred  to  the 
physician,  to  see  if  the  cause  be  a  removable  one.  Ex- 
perience shows  brilliant  results  from  surgical  treatment 
where  the  cause  is  peripheral ;  less  satisfactory  results  are 
observed  when  the  trouble  is  of  central  origin.  Given 
a  pupil  with  a  speech  defect,  he  should  become  at  once 
a  subject  for  special  consideration  from  the  teacher,  and 
never  should  his  misfortune  be  paraded  before  his  fellow 
pupils  for  ridicule.  He  should  not  be  called  upon  for 
special  exercises,  such  as  declaiming,  until  he  has  had 
sufficient  training  to  give  him  mastery  over  his  voice. 
Let  him  follow  this  primary  rule :  in  speaking,  whenever 
the  impediment  is  encountered,  stop  immediately,  compose 
one's  self,  begin  again,  and  stop  each  time  trouble  is  en- 
countered. 

A  great  deal  of  training  should  be  given  privately,  and 
the  child  encouraged  to  think  that  persistent  efforts  on  his 
part,  when  alone,  in  speaking  aloud,  will  greatly  benefit 


The  Vocal   Organs.  95 

him.  He  should  be  told  of  the  illustrious  example  of 
Demosthenes,  whose  first  public  speech  made  him  the 
butt  of  ridicule,  on  account  of  his  imperfect  utterance, 
and  who,  after  months  of  patient  effort,  in  speaking  only 
to  the  waves  on  the  seashore,  mastered  the  situation  and 
became  one  of  the  greatest  orators  the  world  has  ever 
known. 

Sir  Morrell  Mackenzie,  the  greatest  of  authorities  on 
the  human  \oice,  emphasizes  the  point  of  early  training: 
"If  there  is  any  doubt  as  to  when  it  is  best  to  begin  the 
training  of  the  singing  voice,  there  can  be  none  as  to 
commencing  the  education  of  the  speaking  voice.  It  can 
hardly  be  begun  too  soon ;  in  this  way  faults  of  production 
and  articulation  can  be  prevented,  or,  as  it  were, 
'strangled  in  the  cradle,'  which  in  after  life  can  only  be 
got  rid  of  with  infinite  trouble  and  vexation  of  spirit. 
Too  much  stress  cannot  be  laid  on  the  importance  of  sur- 
rounding a  child,  even  before  it  can  speak,  with  persons 
whose  accents  and  utterance  are  pure  and  refined.  The 
Greeks,  at  their  period  of  highest  culture,  were  keenly 
alive  to  the  necessity  of  this,  and  would  allow  no  ser- 
vants near  their  children,  but  such  as  spoke  correctly." 

This  strong  advice  is  in  strange  contrast  with  the  per- 
nicious habit  many  parents  have  of  speaking  to  their  chil- 
dren in  a  foolish  lingo  of  "baby  talk." 


96         The  Hygiene  of  the  Schoolroom. 

Various  other  faults  of  speech  will  entirely  yield  to 
proper  care.  Some  children  have  a  rapid,  jerky  way  of 
speaking  that  mumbles  many  of  the  words  together;  some 
lisp  and  drawl;  ethers  have  a  thick,  indistinct  tone.  All 
departures  of  this  nature  should  concern  the  teacher  and 
receive  her  earnest  attention.  She  should  correct  the 
child  over  and  over  again  until  the  proper  sounds  are 
produced.  There  is  no  system  or  method  which  will 
benefit  those  troubled  with  defective  speech  so  much  as 
intelligent  and  persistent  efforts  on  the  part  of  the  teacher 
and  parent  in  clear  enunciation.  The  child  will  ordi- 
narily be  shy  and  sensitive  to  the  ridicule  that  his  speech 
brings  upon  him,  and  speak  in  a  low,  muttering  tone. 
He  should  receive  sympathy  and  encouragement  always, 
and  be  instructed  to  produce  loud,  clear  sounds,  bringing 
strongly  into  play  the  abdominal  muscles  and  diaphragm. 
Owing  to  individual  peculiarities,  some  children  seem  in- 
capable of  pronouncing  such  sounds  as  "r,"  making  it 
"w,"  but  practice  will  help  greatly. 

On  the  other  hand,  many  speech  defects  result  from 
congenital  defects  in  the  lips,  the  tongue,  the  soft  and.  the 
hard  palate.  Hare-lip  is  a  congenital  fissure  of  the  lips 
and  may  extend  back  through  the  bony  parts  of  the 
mouth,  causing  cleft  palate.  It  is  a  common  deformity 
and  interferes  greatly  with  proper  speech.  Such  cases 
should  be  operated  on  in  infancy,  long  before  the  patient 


The  Vocal  Organs.  97 

reaches  school  age;  but  even  in  school,  it  should  be  re- 
membered, it  is  not  too  late  to  operate  successfully. 
Tongue-tie  is  an  affection  where  the  tongue  is  bound 
down  and  cannot  be  protruded  beyond  the  teeth.  It  is  a 
serious  drawback  to  proper  articulation,  but  is  .easily  and 
simply  remedied  by  dividing  the  tongue-string.  Cleft 
palate  is  an  unnatural,  congenital  opening  in  the  roof  of 
the  mouth  and  may  involve  the  soft  palate  or  extend  into 
the  hard  palate.  The  severe  forms  occasion  serious  dis- 
turbances. In  swallowing,  the  liquids  pass  through  this 
false  opening  and  out  through  the  nose.  As  the  child 
learns  to  speak,  his  articulation  is  faulty  and  his  voice 
very  nasal.  Early  operation  is  advisable,  before  school 
age  and  preferable  before  the  child  has  learned  to  talk. 
When  the  operation  is  undertaken  late,  even  if  it  is  suc- 
cessful, the  child  will  have  great  difficulty  in  overcoming 
the  faulty  habits  in  speaking  already  acquired.  Defec- 
tive and  irregular  teeth  also  are  an  impediment  to  proper 
enunciation.  The  teeth  of  school  children  often  receive 
scanty  care,  and,  as  a  rule,  are  in  poor  condition.  Ped- 
ley,  of  England,  examined  the  teeth  of  3,800  school  chil- 
dren, and  found  that  75  per  cent,  of  that  number  were 
badly  affected.  The  real  province  of  the  school  author- 
ities in  such  matters  is  not  great,  but  much  good  will 
come  from  the  teacher's  suggestions  to  care  for  the  teeth 
with  frequent  cleansings  with  the  brush. 


CHAPTER  X 
RELATION  OF  CONTAGIOUS  DISEASES  TO  THE  SCHOOL 

Ordinarily  the  terms  "contagious"  and  "infectious" 
are  used  synonymously  as  referring  to  diseases  com- 
municable from  one  person  to  another.  There  is,  how- 
ever, a  distinction.  Contagious  diseases  are  usually 
transmitted  by  direct  contact,  while  infectious  diseases 
are  those  borne  by  water,  air  or  food.  The  distinction  is 
a  fine  one,  and  for  ordinary  purposes  the  term  "con- 
tagious" may  be  used  to  cover  all  diseases  that  are  popu- 
larly spoken  of  as  "catching." 

The  rules  and  principles  intended  for  the  public 
schools  in  relation  to  contagious  diseases  are  just 
as  applicable  to  private,  parochial  and  Sunday 
schools.  The  Attorney  General  of  the  State  of  New 
York  in  1903  rendered  an  opinion  to  the  effect  that 
though  the  State  Health  law  does  not  compel 
parochial  school  authorities  to  exclude  unvaccinated  chil- 
dren from  attending  school,  yet  the  local  board  of  health 
may  direct  general  vaccination,  and  provide  a  penalty  for 
non-compliance.  The  opinion,  the  first  one  passed  upon 


Contagious  Diseases. 


99 


this  question,  was  given  as  a  result  of  the  situation  at 
Dunkirk,  N.  Y. 

The  principal  diseases  to  be  considered  are 
measles,  smallpox,  mumps,  diphtheria,  scarlet  fever, 
whooping-cough,  typhoid  fever,  chicken-pox,  erysip- 
elas, influenza,  tuberculosis,  typhus  fever,  and  con- 
tagious eye  and  skin  diseases.  The  diseases  enumer- 
ated vary  greatly  in  their  contagiousness,  some  being 
especially  violent  in  their  ravages,  while  others  are  far 
more  inert. 

Dr.  Louis  C.  Parkes  has  arranged  a  very  comprehen- 
sive table  of  communicable  diseases : 


Smallpox. 

Scarlet  fever. 
CLASS  A. 

Measles. 
Contagion,      usually^    German  mfeasles> 

Mumps. 
Chicken  Pox. 


air  borne. 


Yellow  fever.* 
CLASS  B.  Cholera. 

Contagion,      usually^    Enteric  fever, 
air  or  water  borne.    |    Dysentery. 
Diarrhoea. 


Whooping  Cough. 
Influenza. 
Typhus. 
Erysipelas. 
Epidemic  pneumonia 


Diphtheria. 


*  Discoveries  in  1902,  by  means  of  the  experiments  of  Reed,  Carroll,  Agramonte, 
Guiteras,  and  others,  proved  beyond  a  reasonable  doubt  that  yellow  fever  is  inoculated 
by  the  sting  of  mosquitoes. 


ioo       The  Hygiene  of  the  Schoolroom. 


Foot  and  mouth  disease. 


CLASS  C.  I  Leprosy. 

Contagion,      usually  ^  Glanders, 

by  inoculation.          I  Rabies, 

i  Vaccinia. 


Erysipelas. 
Pyaemia. 


CLASS  D. 

Surface  lesion  neces- 
sary for  contagion 
air  borne  or  direct- 
ly by  inoculation. 

CLASS  E.  Tuberculosis. 

Contagion,  air  borne  j   Cerebro-spinal  menin- 
or  by  inoculation.   I         gitis. 


Opthalmia. 


Tetanus. 


Septicaemia. 


C  Scrofula. 
/  Lupus. 


When  a  disease  presents  itself  in  a  community  only  in  a 
few  and  widely  scattered  cases,  it  is  spoken  of  as  being 
"sporadic."  When  a  number  of  cases  of  a  contagious 
disease  are  found  in  a  community,  it  is  said  to  be  "epi- 
demic." A  disease  would  be  "epidemic"  when  found  in  a 
community  in  the  following  proportions : 


For  a  population  of 


ioo 5    per  hundred. 

500 4      " 

2,000  to      5,000 22%  per  thousand. 

6,000  to    10,000 16       "          " 

20,000  to    50,000 8  per  ten  thousand 

50,000  to  100,000 4         "  " 

200,000  and  over i         "  " 


Contagious  Diseases. 


roi 


Most  of  the  contagious  diseases  are  caused  by  germs 
entering  the  system,  multiplying  and  thriving  and  by 
their  presence  causing  the  particular  ailment.  The  space 
of  time  elapsing  between  the  entrance  cf  the  infection 
and  the  manifestation  of  the  disease  is  known  as  the 
"period  of  incubation."  It  varies  as  follows : 


DISEASE. 

PERIOD  OF 
INCUBATION. 

APPEARANCE  OF 
ERUPTIONS. 

PERIOD  OF  INFEC- 
TION. 

Smallpox. 

1  1  to  14,  usual- 
ly 12  days. 

Second  or  third 
day  on  face  or 
forehead. 

Three  to  seven 
weeks. 

Chicken-pox. 

7  to  14,  usually 
12  days. 

First  to  fourth  day 
of  fever,  on  trunk 
and  shoulders. 

Four  weeks  ;  un- 
til every  scab 
has  fallen. 

Measles. 

loto  14,  usual- 
ly 10  days, 

Fourth  day  of 
fever,  on  fore- 
head. 

During  initial 
symptoms  and 
until  end  of  des- 

quamation. 

German  measles. 

7  to  1  5,  usually 
14  days. 

First  to  fourth  day 
fever,  on  face. 

Same  as  measles. 

Scarlet  fever. 

i  to  7,  usually 
3  to  4  days. 

Second  day  of 
fever,  on  trunk. 

End  of  desquama 
tion    and    com- 
plete disappear- 
ance   of    throat 

symptoms, 

Diphtheria. 

2  to  i  o,  usually 
2  to  3  days. 

No  eruption;  rash 
sometimes  on 
second  or  third 
day  of  fever. 

Until  ail  dis- 
charges  have 
ceased  and 
throat  symp- 
toms have  dis- 
appeared. 

it>2'       The  :  Hygiene  of  the  Schoolroom. 


DISEASE. 


PERIOD  OF 
INCUBATION. 


APPEARANCE  OF 
ERUPTIONS. 


PERIOD  OF  INFEC- 
TION. 


Whooping 
cough. 


Typhoid  fever. 


Yellow  fever. 


Mumps. 


4  to  14,  usually 
7  days. 


to  26,  usually 
12  days. 


i  to  7,  usually 
3  to  4  days. 


14  to  21  days. 


No  eruption. 


Sometimes  spots 
on  abdomen  be- 
tween sixth  and 
fourteenth  days. 

Jaundice  some- 
times on  second 
day  of  fever. 

No  eruption. 


During  catarrhal 
stage  and  as 
long  as  whoop 
lasts. 

Until  diarrhoea 
ceases. 


Uutil  fever  ceases. 


Until  swelling  has 
disappeared. 


Dr.  Meredith  Young,  of  Crewe,  England,  divides  the 
contagious  diseases  into  two  classes,  A  and  B. 

Those  in  Class  A  are :  Scarlatina,  diphtheria,  measles, 
rubella,  mumps,  pertussis,  varicella,  variola  and  influenza. 
In  Class  B  are  mentioned  erysipelas,  ringworm,  diseases 
of  scalp,  scabies  and  purulent  conjunctivitis. 

When  diseases  of  Class  A  occur,  all  children  living  in 
the  same  house  are  excluded  from  school ;  as  for  Class  B, 
the  exclusion  of  the  patient  alone  is  demanded. 

The  objection  to  such  a  classification  would  be  found 
in  the  difficulty  of  carrying  out  as  stringent  exclusion 
from  school  with  influenza  as  with  scarlatina. 

Usually  the  child  that  has  received  the  infection  re- 
mains at  school  while  the  disease  is  breeding. 


Contagious  Diseases.  103 

Certain  of  the  diseases  enumerated  have  a  character- 
istic eruption,  viz. :  smallpox,  chicken-pox,  scarlet  fever, 
and  measles*  These  are  known  as  the  eruptive  fevers. 
The  time  elapsing  from  the  first  symptoms  of  illness  to 
the  breaking  of  the  eruption,  or  "rash,"  is  spoken  of  as 
the  period  of  "invasion."  With  smallpox  it  is  from  two 
to  three  days ;  with  measles,  four  days ;  with  scarlet  fever, 
two  days;  with  chicken-pox,  one  or  two  days. 

Thanks  to  the  great  discovery  of  vaccination  by  Ed- 
ward Jenner  in  1798,  smallpox  has  not  now  the  important 
place  in  the  list  of  school  diseases  it  once  had.  Living 
in  this  generation,  almost  freed  from  this  horrible  plague, 
we  can  hardly  picture  the  devastation  this  disease 
formerly  caused.  Macaulay,  the  English  historian,  called 
smallpox  "the  most  terrible  of  all  the  ministers  of  death." 
Professor  Wernher,  in  his  work  "Zur  Impffrage,"  says : 
"Before  the  introduction  of  vaccination,  smallpox  had 
become  a  permanent  disease  which  never  entirely  ceased 
in  any  one  year,  and  every  three  or  five  years  became  a 
great  epidemic.  In  non-epidemic  years,  one-tenth  of  all 
mortality  was  from  variola;  in  epidemic  years,  one-half. 
Very  few  men  escaped  smallpox  till  old  age;  almost, 
every  one  sickened  at  least  once  in  his  life  of  this  hor- 
rible, murderous  disease.  Countless  mortals  were  maimed 
by  loss  of  sight.  Of  new-born  children,  one-third  died 


IO4       The  Hygiene  of  the  Schoolroom. 

of  smallpox  before  their  first  year;  one-half  before  their 
fifth  year  of  life.  There  was  no  family  which  had  not 
had  heavy  losses  to  deplore.  Men  accepted  the  pest  as 
an  unavoidable  fate.  It  was  the  principal  factor  which 
deterred  or  kept  back  the  population  from  progress;  yet 
the  efforts  of  many  ignorant  mortals  are  directed  toward 
a  return  to  these  conditions."  Looking  at  present  con- 
ditions, the  same  author  says :  "We  now  find  no  child 
mortality  among  vaccinated  children;  among  adults  also, 
whenever  vaccination  and  revaccination  are  maintained, 
mortality  from  smallpox  is  at  an  end."  That  vaccination 
does  prevent  it  is  shown  by  Prussian  statistics  of  the  ap- 
proximate average  annual  rate  of  deaths  from  smallpox 
per  million  before  the  practice  of  vaccination  and  after. 
Before  the  introduction  of  vaccination  the  rate  was 
3,321 ;  after,  only  56. 

An  inspector  of  contagious  diseases  in  New  York  said : 
"During  our  nine  years  of  service  in  the  Health  Depart- 
ment of  New  York,  I  have  never  seen  a  case  of  small- 
pox in  a  person  who  had  been  vaccinated  successfully 
within  five  years,  and  the  number  of  cases  I  have  seen 
mount  into  hundreds.  During  that  period,  I  have  seen 
only  one  inspector  contract  smallpox,  and  he  was  the  only 
inspector  who  disbelieved  in  vaccination  and  refused  to 
have  it  performed  upon  himself." 


Contagious  Diseases.  105 

Drs.  W.  M.  Welch  and  Jay  F.  Scliamberg  (Philadel- 
phia Medical  Journal)  give  their  experience  in  the  Phila- 
delphia Hospital  for  Contagious  Diseases.  They  state  that 
in  one  year's  experience  (after  1901)  about  three  hun- 
dred cases  of  smallpox  were  treated  at  this  hos- 
pital. Of  this  number  not  a  single  patient  had  been  re- 
cently successfully  vaccinated.  The  shortest  period 
elapsing  between  a  successful  vaccination  and  the  con- 
traction of  the  disease  was  five  years.  In  this  case, 
which  occurred  in  a  boy  of  eleven  years  old,  the  eruption 
consisted  of  only  a  score  of  papules,  which  scarcely  de- 
veloped into  vesicles,  and  dried  up  in  a  few  days.  It 
was  not  found  necessary  to  confine  the  lad  to  bed.  While 
the  majority  of  the  patients  admitted  were  unvaccinated, 
a  very  large  number  had  been  vaccinated  in  infancy.  To 
the  best  of  the  writer's  knowledge,  none,  save  the  boy 
mentioned,  had  been  successfully  vaccinated  within  the 
past  ten  years.  The  writers  believe  that  it  may  be  laid 
down  as  a  rule  that  if  a  child  be  successfully  vaccinated 
in  infancy,  and  again  at  the  age  of  puberty,  the  protection 
will  be  permanent.  The  exceptions  to  this  rule,  how- 
ever, may  be  sufficiently  frequent  to  warrant  a  repetition 
of  the  vaccination  whenever  there  is  exposure  to  small- 
pox. They  prefer  the  glycerinated  lymph  in  such  cases. 
Smallpox  seldom  manifests  itself  in  the  school,  and 


io6       The  Hygiene  of  the  Schoolroom. 

the  only  phase  of  this  subject  of  interest  is  that  of  vac- 
cination. Immunity  from  smallpox  in  recent  years  has 
made  the  people  careless  and  even  defiant  of  the  laws 
governing  vaccination.  The  "anti-vaccinationists"  have 
in  many  places  defied  the  school  authorities  who  de- 
manded compulsory  vaccination  among  school  children. 
It  is  strange  that  such  a  blessing  can  be  so  lightly  looked 
upon ;  and  it  usually  requires  several  cases  of  smallpox  in  a 
community  before  the  people  will  avail  themselves  of  the 
opportunity  to  be  vaccinated.  It  should  be  borne  in  mind 
that  vaccination  and  modern  sanitary  science  have  almost 
wiped  smallpox  from  the  face  of  the  earth,  and  that  any 
relaxation  of  the  means  that  secured  this  desirable  end 
may  serve  to  bring  back  the  scourge  once  more.  All 
children  should  be  vaccinated  before  entering  school, 
unless  the  health  officer  can  satisfy  himself  that  the  state 
of  the  child's  health  is  such  as  would  make  the  operation 
inimical  to  him. 

Compulsory  vaccination  is  demanded  by  most  school 
boards  and  state  laws.  A  number  of  complaints,  how- 
ever, have  been  noticed  within  the  past  two  years,  of 
laxity  on  the  part  of  schoo!  boards  in  relation  to  the  vac- 
cination laws.  In  many  cases  it  is  because  the  parents 
do  not  believe  in  efficacy  of  inoculation,  or  because  they 
fear  some  evil  result.  But  the  proverbial  vaccination 


Contagious  Diseases.  107 

stories,  telling  of  horrible  results,  are  gross  exaggera- 
tions, not  to  be  credited,  as  in  not  one  case  in  a  thousand 
are  any  untoward  results  noted. 

School  boards  should  always  require  each  child  upon 
entering  the  schools  to  be  successfully  vaccinated.  This 
means  that  if  the  inoculation  fails  to  "take"  at  the  first, 
trial,  it  should  be  repeated  again  and  again  until  it 
does  "take."  Usually  the  certificate  given  to  a  success- 
fully vaccinated  child  when  entering  school  is  allowed 
to  stand  indefinitely;  but  as  the  immunity  is  supposed  to 
disappear  in  from  five  to  seven  years,  revaccination 
should  be  insisted  upon  from  time  to  time. 

When  smallpox  is  epidemic  in  a  community  all  the  school 
children  should  be  vaccinated  regardless  of  previous 
scars.  If  the  immunity  still  continues,  the  vaccination 
will  have  no  effect,  and  if  successful  it  only  proves  the 
necessity  of  the  added  safeguard.  There  may  be  some 
few  children  in  a  community  who,  for  physical  reasons, 
should  be  excused  from  vaccination;  but  the  number 
rightfully  excluded  would  be  very  small.  Pressure  is 
often  brought  to  bear  upon  the  physician  by  the  parent 
for  a  certificate  of  exemption,  and  it  would  be  wise  for 
school  boards  to  demand  the  signature  of  two  physicians 
to  such  a  certificate. 

The  U.  S.  Marine  Hospital  Service,  in  its  bulletin  on 


io8       The  Hygiene  of  the  Schoolroom. 

"Smallpox,"  decries  the  necessity  at  all  of  such  exemp- 
tions and  pointedly  says  that  there  are  only  two  classes  in 
a  community  who  deserve  to  be  exempt — "first,  those  that 
have  already  had  smallpox,  and,  secondly — those  that  are 
dead." 

Chicken-pox  is  a  harmless  disease  which  has  interest 
only  from  its  liability  to  be  mistaken  for  smallpox.  It 
manifests  itself  in  the  shape  of  small,  round  rose-colored 
sores  scattered  over  the  body.  But  however  mild  it  is  in 
its  nature,  no  child  suffering  from  it  should  be  allowed 
at  school. 

The  three  great  "school  diseases"  of  this  clime,  both 
because  of  their  frequency  of  appearance  and  the  serious- 
ness of  their  nature,  are  measles,  scarlet  fever,  and  diph- 
theria. This  does  not  mean  that  they  are  serious  because 
they  always  destroy  life,  but  because  of  the  troublesome 
after-effects  they  leave  upon  the  eyes,  the  ears,  and  the 
voice. 

Measles,  though  the  least  likely  to  be  fatal,  is  the  most 
infectious  of  all,  beginning  to  be  so  several  days  before  the 
eruption  breaks  out.  A  child  coming  down  with  it 
exhibits  symptoms  of  a  severe  cold;  has  headache,  stop- 
page of  the  nose,  tickling  of  the  throat,  sneezing,  in- 
flamed, watery  eyes,  and  a  hard,  dry  cough.  The  erup- 
tion is  in  the  shape  of  small,  red  dots  resembling  flea 


Contagious  Diseases.  109 

bites,  first  appearing  on  the  temples  and  the  forehead, 
and  later  spreading  over  the  entire  body.  Pneumonia 
often  complicates  a  case  of  measles,  making  a  serious 
combination.  A  lingering  cough  or  inflamed  eyes  and 
ears  may  follow.  The  patient  should  keep  his  bed  for  a 
week  and  his  room  for  three  weeks.  If  well  by  this  time, 
he  may  rejoin  his  playmates.  When  a  case  enters  a 
household  where  other  children  are,  all  should  be  enjoined 
from  attending  school.  Epidemics  of  measles  usually 
begin  in  cold  weather. 

Scarlet  fever,  or  scarlatina,  is  a  limited  contagious 
disease  caused  by  a  specific  germ,  and  characterized  by 
fever,  sore  throat,  and  an  eruption.  This  eruption  is  of 
a  bright  scarlet,  forming  first  on  the  chest  and  the  upper 
extremities.  About  the  fifth  day  of  the  fever,  the  rash 
begins  to  peel  off,  and  then  especial  care  should  be  taken, 
as  at  this  time  the  disease  is  most  infectious.  Contagion 
may  come  through  such  mediums  as  library  or  school 
books,  letters,  clothing,  or  toys.  Chronic  nasal  catarrh, 
pneumonia,  heart  and  kidney  trouble,  may  complicate  and 
follow  this  disease,  but  what  is  most  of  all  to  be  feared  is 
the  ear  trouble,  where  the  drumhead  becomes  perforated 
and  a  chronic  discharge  follows.  One  observer,  upon 
investigating  causes  of  deafness  in  four  hundred  persons, 
found  scarlet  fever  to  be  responsible  for  one  hundred  and 


no       The  Hygiene  of  the  Schoolroom. 

forty-four  of  that  number.  A  child  should  not  be  al- 
lowed to  return  to  school  until  four  weeks  after  recovery, 
as  the  disease  continues  to  be  infectious  long  after  the 
patient  is  apparently  restored  to  health. 

Of  the  common  diseases  incident  to  school  life,  diph- 
theria is  the  most  destructive.  In  recent  years,  the  dis- 
covery and  use  of  antitoxin  have  considerably  lessened 
the  mortality,  but  it  is  still  a  difficult  disease  to  combat. 
Its  duration  is  usually  short  and  its  progress  rapid.  Its 
constant  feature  is  the  presence  of  a  white  patch  or 
patches  in  the  throat,  accompanied  by  high  fever  and 
weakness.  Many  cases  are  of  such  slight  nature  and  the 
constitutional  symptoms  so  light  that  little  notice  is  paid 
to  the  affection  by  careless  parents,  and  the  child  con- 
tinues at  school,  infecting  all  about  him.  Peculiarly 
enough,  however,  the  mildest  case  of  this  disease  may 
infect  another  child  with  the  most  violent  type. 

If  there  should  be  no  medical  inspector  connected  with  a 
school,  it  is  an  easy  matter  for  the  teacher,  in  all  cases 
of  "sore  throat"  coming  under  her  notice,  to  make  an 
examination  by  depressing  the  back  portion  of  the 
tongue  with  a  small,  clean  piece  of  wood.  If  there  are 
shown  in  the  throat  any  small  white  spots  or  patches,  the 
child  should  be  immediately  sent  home  to  be  examined  by 
a  physician.  It  is  true  that  white  patches  in  the  throat 


Contagious  Diseases.  in 

do  not  always  indicate  diphtheria,  but  the  teacher  should 
not  be  expected  to  differentiate.  That  can  best  be  done 
by  a  physician,  and  then  only  after  a  culture  is  taken 
from  the  throat  to  be  examined  under  the  microscope  for 
the  detection  of  the  presence  of  diphtheria  bacilli.  Diph- 
theria patients  should  be  carefully  isolated  and  pupils 
from  the  same  family  kept  from  school.  The  child  may 
be  returned  to  school,  if  good  disinfection  has  been  car- 
ried out,  three  weeks  after  recovery. 

Whooping-cough  is  a  disease  far  too  lightly  considered 
both  at  home  and  at  school.  Ordinarily,  little  attention 
is  given  to  it  by  the  school  authorities.  Children  are 
often  allowed  to  continue  at  school  while  suffering  from 
it,  infecting  those  around  them  at  every  cough,  and  an- 
noying all  present  by  each  spasmodic  outburst.  And, 
although  in  most  cases  the  child  recovers,  whooping- 
cough  is  far  more  dangerous  than  is  usually  supposed. 
Dolan  ranks  it  third  among  the  fatal  diseases  of  child- 
hood in  England;  and  Smith,  in  New  York,  states  that 
one  out  of  every  seventy-six  deaths  there  is  due  to  whoop- 
ing-cough. It  is  not  alone  in  the  disease  itself  that  the 
mortality  lies,  but  in  the  complication  so  often  resulting, 
such  as  convulsions  and  pneumonia.  Children  with  this 
disease  should  be  kept  from  school  until  the  physician 
certifies  to  complete  recovery.  Unfortunately,  the  dis- 


ii2       The  Hygiene  of  the  Schoolroom. 

ease  is  a  long-standing  one,  running  from  six  weeks  to 
as  many  months,  and  parents  will  protest  strenuously 
against  having  the  child  excluded  from  school  for  this 
long  period  of  time.  There  is  no  alternative,  however, 
when  we  consider  the  extreme  contagiousness  of  whoop- 
ing-cough and  the  great  distress  the  infliction  of  the 
disease  on  others  would  cause. 

Tuberculosis,  or,  as  it  is  popularly  called,  consumption, 
is  sometimes  encountered  in  the  schoolroom.  Since  the 
discovery  by  Koch  of  the  cause  of  tuberculosis,  the  con- 
viction of  late  years  has  grown  that  this  disease  is  com- 
municable and  to  a  great  measure  preventable.  With  a 
view  to  preventing  the  spread  of  tuberculosis,  the  Board 
of  Health  of  New  York  City  issued  the  following  in- 
struction : 

"Consumption  is  a  disease  which  can  be  taken  from 
others  and  is  not  simply  caused  by  colds.  A  cold  may 
make  it  easier  to  take  the  disease.  It  is  usually  caused 
by  germs  which  enter  the  body  with  the  air  breathed. 
The  matter  which  consumptives  cough  or  spjt  up  contains 
these  germs  in  great  numbers :  frequently  millions  are 
discharged  in  a  single  day.  This  matter,  spit  upon  the 
floor,  wall,  or  elsewhere,  is  apt  to  dry,  become  pulverized, 
and  float  in  the  air  as  dust.  This  dust  contains  the 
germs,  and  thus  they  enter  the  body  with  the  air  breathed. 


Contagious  Diseases.  113 

"The  breath  of  a  consumptive  does  not  contain  the 
germs  and  will  not  produce  the  disease.  A  well  person 
catches  the  disease  from  a  consumptive  only  by  in  some 
way  taking  the  matter  coughed  up  by  the  consumptive." 

A  child  known  to  be  suffering  from  tuberculosis  must 
of  necessity  be  excluded  from  school.  With  this  disease 
the  outward  signs  noticeable  to  a  teacher  would  be 
cough,  paleness  of  the  skin,  difficulty  of  breathing,  and 
weakness.  Any  pupil  who  continues  to  cough  for  some 
time  should  be  examined  and  a  physician's  opinion  be 
requested  as  to  whether  the  trouble  is  contagious.  Ex- 
pectoration upon  the  floor  should  be  forbidden  at  all 
times,  whether  a  cough  be  present  or  not. 

Mumps,  or  parotitis,  is  an  acute  infectious  disease, 
outwardly  manifested  by  swelling  of  the  parotid  gland, 
which  lies  immediately  below  the  external  ear.  Mumps 
will  be  encountered  in  the  schoolroom  more  often  than 
any  of  the  diseases  previously  spoken  of,  as  the  child 
usually  complains  but  little  of  sickness,  and  the  infectious 
nature  of  the  ailment  is  not  rightly  recognized.  It  is  not 
dangerous  to  life,  but  should  be  guarded  against  by  re- 
fusal to  admit  any  child  suffering  from  this  disease. 

Typhoid  fever  is  very  apt  to  manifest  itself  during 
school  life,  as  a  large  number  of  cases  occur  between  the 
ages  of  five  and  fifteen.  Besides  being  an  especially 


H4       The  Hygiene  of  the  Schoolroom. 

dangerous  disease,  it  deprives  the  child  of  the  advantages 
of  school  for  a  long  period  of  time,  often  many  months. 
It  is  known  to  be  contagious,  and  often  the  avenue  of  the 
disease  is  polluted  milk  or  drinking  water.  If  the  water 
of  a  school  is  from  the  public  water  supply  of  a  city, 
there  are  authorities  who  are  supposed  to  analyze  it  care- 
fully from  time  to  time  for  the  presence  of  any  disease- 
breeding  impurities.  If  the  supply  be  on  the  grounds, 
from  a  well,  it  should  have  a  careful  analysis  at  least 
twice  a  year  to  determine  its  purity. 

Should  two  or  three  or  more  cases  of  typhoid  fever  be 
reported  from  a  single  school,  the  closest  examination 
should  be  given  to  the  building,  lest  the  cause  should  be 
there.  The  water  supply,  the  drainage,  the  closets,  and 
the  cellar,  should  be  the  subjects  for  investigation. 

Typhus  fever,  cerebro-spinal  meningitis  and  erysipelas 
are  contagious  diseases  which  it  will  usually  require  a 
physician  to  discover.  When  epidemic,  they  require  the 
same  precautions  as  spoken  of  with  the  foregoing  dis- 
eases. 

Certain  inflammatory  diseases  of  the  eye  and  skin  are 
contagious.  Any  child  found  with  sore,  watery  eyes,  or 
scabby  sores  upon  the  body,  or  that  peculiar  skin  disease 
known  as  "ringworm,"  should  be  sent  out  as  being  the 
subject  of  a  contagious  disease.  In  some  of  the  large 


Contagious  Diseases.  115 

centres  of  population  contagious  eye  diseases  and  ring- 
worm are  a  source  of  great  concern  to  the  school  author- 
ities. In  New  York  City,  in  1902,  out  of  55,000  pupils 
examined,  6,670,  or  about  12  per  cent,  were  suffering 
from  contagious  eye  diseases;  2,328  of  this  number  had 
trachoma  (granular  lids).  Ringworm  has  been  especially 
common  in  the  larger  cities,  where  the  foreign  element 
predominates.  It  is  a  stubborn  disease  to  combat  and 
lasts  many  weeks.  In  order  that  those  suffering  from  it 
may  not  be  deprived  of  all  their  school  benefits  it  has  been 
recommended  that  separate  schools  be  opened  for  those 
suffering  from  ringworm  or  trachoma.  This  expedient 
has  been  successfully  tri'ed  in  parts  of  Italy  and  Belgium. 
The  diseases  described  are  all,  to  a  greater  or  less 
extent,  communicable,  and  also  largely  preventable.  No 
greater  good  can  be  done  in  school  work  than  by  the 
study  and  application  of  hygiene  to  prevent  these  same 
diseases,  which  annually  make  such  ravages  among  chil- 
dren. The  diseases  for  which  pupils  are  excluded  from 
school  attendance  are  scarlet  fever,  diphtheria,  tonsilitis 
(in  Philadelphia  and  Detroit),  measles,  mumps,  chicken- 
pox,  whooping  cough,  pediculosis,  scabies,  impetigo,  tu- 
berculosis, smallpox,  and  trachoma.  No  matter  how 
carefully  children  may  be  cared  for  at  home,  they  must 
rub  shoulders  with  others  who  know  little  of  the  laws  of 
personal  cleanliness.  At  home  a  child  may  drink  only 


FIG.  26. 

Sanitary  Drinking  Fountain. 


Contagious  Diseases.  117 

from  his  own  cup,  but  at  school  he  too  often  drinks  from 
a  filthy  tin  dipper  that  a  hundred  lips  have  touched  that 
day.  The  wonder  is  that  disease  is  not  more  common  in 
our  schools.  It  behooves  us,  then,  to  study  all  condi- 
tions that  will  serve  to  lessen  this  great  interchange  of 
disease. 

First,  we  must  revert  to  ventilation  again,  and  con- 
sider that  disease  germs  find  a  paradise  in  a  close,  poorly 
ventilated  room.  We  should  also  abolish  the  common 
drinking  cup.  It  should  not  be  tolerated  for  one  day  in 
a  schoolroom.  Each  child  should  have  a  marked  cup  of 
his  own  and  use  that  only. 

An  admirable  means  of  preventing  the  spread  of  many 
diseases  is  by  substituting  for  the  drinking  cup  or  tin 
dipper  a  drinking  fountain,  which  has  been  patented, 
by  means  of  which  the  pupil,  pressing  a  small 
lever  in  the  floor  with  the  foot  causes  a  gentle  stream  of 
water  to  be  thrown  upwards.  The  child  places  the  lips 
to  this  stream  and  drinks;  the  water  flows  back  into  a 
basin  and  out.  Removal  of  the  foot  from  the  lever  stops 
the  supply  of  water.  The  great  advantage  is  that  the  child 
drinks  readily  and  without  touching  the  lips  to  any  cup  or 
dish  of  any  kind.  This  appliance  in  actual  use  is  shown 
in  the  illustration  opposite.  Too  much  cannot  be  said  for 
this  device;  its  general  use  would  undoubtedly  cause  a 
marked  diminution  of  contagious  diseases. 


FIG.   27. 

Sanitary  Drinking  Fountain  in  use. 


Contagious  Diseases.  119 

The  pupil  should  be  enjoined  from  the  very  common 
habit  of  wetting  the  thumb  or  fingers  with  saliva  to 
turn  the  leaves  of  a  book.  This  is  an  unsanitary  practice 
and  an  easy  way  of  introducing  disease  germs  into  the 
mouth. 

The  practice  of  carrying  home  books  or  other  school 
articles  should  be  carefully  looked  after  and  forbidden  in 
cases  where  contagious  diseases  exist.  If,  by  some  over- 
sight, such  articles  are  left  at  homes  where  there  are  such 
diseases,  they  should  be  thoroughly  fumigated  with  for- 
maldehyde vapor  before  they  are  returned  to  the  school. 
This  fumigation  can  easily  be  carried  out  by  placing  the 
books  and  articles  in  question  in  a  small  closet,  closing 
the  door  and  stopping  up  the  keyhole  and  burning  one  or 
two  formaldehyde  candles.  The  books  should  be  set  on 
edges  with  the  leaves  opened  as  much  as  possible. 
When  smallpox,  diphtheria,  or  scarlet  fever  is  epidemic  in 
a  community,  the  carrying  of  any  articles  from  school 
to  home  should  be  prohibited. 

The  use  of  pencil  and  slate  is  rapidly  passing  away, 
and  the  pad  of  paper  and  lead  pencil  are  being  substituted. 
It  is  impossible  to  keep  the  old  slate  clean,  and  usually 
the  attempted  cleaning  is  done  with  saliva.  Its  use  also 
involves  the  necessity  of  sponges  and  slate  cloths,  which 
are  ready  germ  catchers.  When  slates  are  in  constant 


120       The  Hygiene  of  the  Schoolroom. 

Use  it  would  be  well  to  have  them  washed  weekly  with 
a  i  to  5,000  solution  of  bichloride  of  mercury. 

No  common  towel  should  be  used  at  school.  Con- 
tagious skin  and  eye  troubles  find  a  ready  mode  of  inter- 
change through  the  towels.  If  they  are  at  all  necessary, 
there  must  be  one  for  each  pupil.  Schools  that  are  in  use 
both  day  and  evening  demand  extra  care  in  regard  to 
ventilation  and  cleanliness. 

When  a  severe  epidemic  visits  a  particular  school, 
neighborhood,  or  city,  there  should  be  no  hesitancy  in 
closing  all  the  schools  endangered.  This,  as  has  been 
proved  repeatedly,  will  usually  suffice  to  stop  the  spread 
of  the  disease.  Dr.  Walford,  an  English  medical  officer 
of  health,  says :  "I  am  aware  that  it  is  frequently  stated 
that  on  the  closure  of  schools,  children  will  play  together 
in  the  streets  or  meet  in  houses,  and  that  the  epidemic 
will  thus  spread  still  more.  Doubtless  under  these  cir- 
cumstances, there  is  a  probability  of  some  infected  chil- 
dren coming  in  contact  with  healthy  ones,  but  the  danger 
of  spreading  the  infection  must  be  infinitely  greater  when 
a  large  number  of  children  are  congregated  together  for 
hours  in  overcrowded  and  badly-ventilated  schoolrooms." 

If,  during  the  prevalence  of  an  epidemic,  the  schools 
are  not  closed,  it  is  feasible  and  advisable  to  fumigate  the 
rooms  often  by  the  use  of  formaldehyde  vapor.  This 
can  easily  be  done  by  the  janitor  after  school  hours.  The 


Contagious  Diseases.  121 

following  method  of  disinfection  of  a  room  and  its  con- 
tents is  recommended: 

"i.  All  cracks  or  opanings  in  plaster  or  floor  and 
about  the  door  and  windows  should  be  closed  by  cotton 
or  strips  of  cloth. 

"2.  The  books,  papers,  pencils,  etc.,  should  be  spread 
out  upon  desks,  chairs  and  tables  in  order  to  expose  as 
much  surface  as  possible  to  the  disinfectant.  They 
should  not  be  thrown  into  a  heap. 

"3.  For  each  1,000  cubic  feet  of  space  150  centimeters 
(five  ounces)  of  formalin  should  be  placed  in  the  distill- 
ing apparatus  and  distilled  as  quickly  as  possible. 

"4.  The  keyhole  and  spaces  about  the  door  should 
then  be  packed  with  cotton  or  cloth. 

"5.  The  room  should  then  remain  closed  for  at  least 
ten  hours." 

The  use  of  disinfectants  such  as  a  solution  of 
carbolic  acid  (one  part  to  fifty  parts  of  water),  mer- 
curic chloride  (one  part  to  a  thousand  parts  of  water), 
and  permanganate  of  potassium  (one  part  to  a  thousand 
parts  of  water),  about  the  water-closets  is  always  ad- 
visable, and  especially  so  in  epidemics.  Many  janitors 
place  too  much  reliance  on  disinfectants,  and  think  that 
no  matter  how  filthy  a  corner  may  be,  liberal  sprinkling 
of  chloride  of  lime,  or  some  such  agent,  will  immediately 
purify  it.  The  best  disinfectant  is  cleanliness,  which 


122       The  Hygiene  of  the  Schoolroom. 

should  always  be  the  advance  guard  of  the  other  means 
employed. 

Schools  that  have  the  benefit  of  the  daily  examination 
of  the  medical  inspector  are  indeed  fortunate,  as  the 
burden  of  a  great  responsibility  is  taken  from  the  teach- 
ers. In  schools  not  so  fortunate,  the  teacher  should  make 
careful  daily  inquiries  regarding  the  health  of  the  pupils 
and  also  the  health  of  the  other  inmates  of  the  pupils' 
household.  In  this  way  many  contagious  diseases  will 
be  discovered  and  reported  to  the  proper  official  for  in- 
vestigation. Many  families  treat,  without  a  physician's 
aid  or  any  attempts  at  isolation,  such  diseases  as  diph- 
theria, measles,  and  scarlet  fever,  often  being  afraid  to 
report  to  the  Health  Board,  lest  the  laboring  members 
of  the  family  may  be  denied  their  usual  work. 

Every  school  board  should  adopt  careful  and  stringent 
regulations  regarding  contagious  diseases  and  the  school. 
The  Health  Board  of  the  City  of  New  York  has  approved 
a  number  of  recommendations  suggested  by  Professor 
Herman  M.  Biggs,  the  department  bacteriologist,  and 
ordered  that  a  copy  be  sent  to  the  Board  of  Education. 
Some  of  the  recommendations  are  as  follows : 

"i.  The  use  of  slates,  slate  pencils,  and  sponges  shall 
be  discontinued  in  all  the  public  schools. 

"2.     According  to  requirement,  pupils  shall  be  supplied 


Contagious  Diseases.  123 

with  pencils  and  penholders,  each  pupil  to  retain  those 
received  in  a  box  provided  for  the  purpose,  such  box  to 
be  marked  with  the  pupil's  name.  Pencils  and  penholders 
shall  not  be  transferred  from  one  pupil  to  another  without 
suitable  disinfection. 

"3.  All  school  property  left  in  the  school  building  by  a 
child  sick  with  any  contagious  disease,  and  all  such  prop- 
erty found  in  an  apartment  occupied  by  a  family  in  which 
a  case  of  smallpox,  typhus  fever,  diphtheria,  scarlet  fever, 
or  measles  has  occurred,  shall  be  taken  by  the  Health 
Department  for  disinfection  or  destruction. 

• 

"4.  Books  which  are  taken  home  by  pupils  shall  be 
covered  regularly  once  a  month  with  brown  manila  paper. 

"5.  Places  for  drinking  water  on  the  ground  floors  of 
the  school  buildings  shall  be  discontinued,  and  a  covered 
pitcher  provided  for  each  classroom,  in  which  fresh  water 
shall  be  placed  before  every  session.  A  numbered  cup  to  be 
kept  in  the  classroom  shall  be  issued  to  each  pupil.  No 
interchange  of  cups  shall  be  allowed. 

"Provision  is  proposed  for  the  exclusion  of  children  in 
whose  homes  there  may  be  cases  of  contagious  disease, 
and  for  a  report  by  teachers  to  the  Board  of  Health  of  all 
cases  of  sickness  among  the  pupils.  Finally,  the  recom- 
mendations provide  for  more  closet  room  for  hanging 


124       The   Hygiene  of  the  Schoolroom. 

clothes,  and  prohibit  principal  and  teachers  from  sending 
one  pupil  to  the  house  of  another  for  any  reason." 

Teachers  or  the  medical  officer  should  teach  the  pupils 
the  great  advantages  of  daily  bathing  and  the  immunity 
from  contagious  diseases  it  affords.  The  medical  director 
of  a  boys'  boarding  school  in  England  stated  that  the 
daily  practice  of  head  to  foot  bathing  in  his  school  reduced 
infectious  diseases  to  one-third  of  the  number  previous 
to  the  establishment  of  this  practice.  In  some  schools 
instruction  must  go  still  farther;  children  should  be  en- 
couraged to  be  clean  in  person  and  clothes,  especially  the 
underclothes.  So  much  of  disease  is  given  off  by  the 
skin  and  so  much  disease  finds  its  way  into  the  body 
through  the  skin  that  it  is  essential  for  a  healthy  body  to 
have  a  clean,  active  skin.  This  cannot  be  had  when 
changing  of  underclothes  is  neglected  and  accumulated 
dirt  blocks  up  the  small  invisible  pores  of  the  skin. 

Often  a  teacher  may  wish  to  know  whether  a  complain- 
ing child  is  really  ill  or  only  affecting  to  be  so.  During  the 
presence  of  an  epidemic  it  would  be  wise  for  the  teacher 
to  take  the  temperature  and  pulse  of  the  child.  To  obtain 
the  temperature,  or  bodily  heat,  it  is  necessary  to  have  a 
small  clinical  thermometer,  the  bulb  of  which  is  placed 
underneath  the  tongue,  with  closed  lips,  and  allowed  to 
remain  there  three  minutes.  Normally,  when  removed 


Contagious  Diseases.  125 

it  should  be  98.2°F,  and  any  elevation  of  this  should  be 
noted  and  the  child  sent  home.  When  a  thermometer  is 
used,  it  should  first  be  thoroughly  cleansed  and  shaken 
so  that  the  mercury  will  stand  lower  in  the  column  than 
the  normal  point.  The  pulse  of  healthy  children  of 
school  age  will  vary  from  72  to  80. 

Acute  anterior  poliomyelitis,  or  infantile  paralysis,  has 
become  within  the  past  three  years  a  serious  condition 
demanding  the  attention  of  health  and  school  officials. 
The  disease  has  been  long  known  to  medical  science  and 
is  in  no  sense  "  new,"  but  its  tendency  to  occur  in  serious 
epidemics  seems  to  be  on  the  increase. 

Epidemics  in  Italy  were  reported  as  far  back  as  1856, 
but  only  for  the  past  three  years  has  it  been  so  prevalent 
in  America.  Fortunately  it  is  generally  a  disease  of  the 
summer  months,  when  children  are  out  of  school  and 
contagion  less  probable. 

In  Rhode  Island  the  distribution  as  to  months  and 
ages  for  1910  was  as  follows: 


March. 

April. 

May.   . 

June. 

July. 

I 

0 

4 

5 

46 

August. 

September. 

October. 

November. 

December. 

70 

65 

9 

4 

2 

126        The  Hygiene  of  the  Schoolroom. 
By  ages: 


Under  I  year. 

1-3  years. 

3-5  years. 

23 

81 

52 

5-10  years. 

10  years  and  oyr. 

28 

22 

Of  those  cases  over  ten  years  of  age  there  were  3  at  ten 
years;  3  at  twelve  years;  I  at  thirteen  years;  5  at 
fourteen  years;  I  at  fifteen  years;  4  at  sixteen  years;  I 
at  eighteen  years;  3  at  nineteen  years;  I  at  twenty-four 
years. 

The  causative  factor  is  probably  some  form  of  bacteria, 
although  its  definite  nature  has  not  been  determined. 
Flexner,  of  New  York,  has  made  valuable  studies  in 
proving  the  contagious  nature  of  the  disease,  and  many 
research  laboratories  are  now  at  work  on  the  problem. 
Unfortunately,  it  is  not  a  disease  that  can  be  recognized 
in  advance  by  any  signs  heralding  its  approach,  as  the 
beginning  symptoms  are  those  common  to  many  ailments 
of  children. 

Usually  fever  and  vomiting,  perhaps  diarrhoea,  are 
noticed,  and  the  paralysis  of  one  or  both  legs  lollows  in 
from  one  to  four  days  without  any  other  warning.  The 
arms,  muscles  of  the  face,  neck,  and  back  are  also  some- 
times involved. 


Contagious  Diseases.  127 

The  paralysis,  which  finds  its  origin  in  the  anterior 
horns  of  the  spinal  column,  may  be  permanent  or  may 
improve,  with  partial  restoration  of  functions,  or  entire 
recovery  may  result.  It  has  been  definitely  decided  that 
it  is  a  contagious  disease,  and  many  states  make  it 
mandatory  upon  physicians  to  report  every  case  to  the 
health  authorities. 

The  Rhode  Island  State  Board  of  Health,  after  an 
extensive  experience  with  infantile  paralysis,  offers  the 
following  suggestions  as  best  in  keeping  with  our  present 
light  on  the  subject: 

Quarantine  or  precautions  against  spread  of  the 
disease:  As  with  all  other  communicable  diseases,  the 
practice  varies  with  the  intelligence  and  environment 
of  the  cases.  Having  the  history  of  so  few  cases  succeed- 
ing in  families  where  many  children  have  been  living 
together  and  in  institutions  where  many  children  are 
brought  into  the  closest  contact  with  the  patient,  it 
would  seem  that  quarantine  to  be  imposed  should  reach 
only  so  far  as  shall  give  the  least  unnecessary  annoyance 
to  those  who  are  associated  with  the  cases  affected.  In 
the  presence  of  our  present  limited  knowledge  of  the 
mode  of  infection,  it  is  deemed  desirable  to  separate  the 
case  from  other  members  of  the  family,  except  for  the 


128        The  Hygiene  of  the  Schoolroom. 

necessary  attendance  of  the  nurse.  Immediate  disin- 
fection by  hot  water  should  be  made  of  all  the  secretions 
coming  from  the  mouth  of  the  patient,  and  of  the  excreta, 
also  of  all  utensils  which  have  been  in  contact  with  the 
patient's  mouth,  including  cups,  spoons,  food,  and  not 
forgetting  the  clinical  thermometer. 

This  isolation  of  the  patient  should  be  kept  up  for 
the  probable  period  of  contagion  or  transmissibility, 
which  may  be  considered  a  period  of  four  weeks.  The 
period  of  quarantine  of  the  unaffected  children  in  the 
family  should  be  for  the  maximum  assumed  period  of 
incubation,  namely,  fourteen  days,  and  for  discontinuance 
of  the  isolation  of  the  patient,  about  twenty-eight  days, 
or  twice  the  period  of  incubation,  dating  from  the  day 
of  the  appearance  of  the  paralysis. 

While  these  periods  are  arbitrary,  and  it  may  be 
assumed  by  analogy  with  diphtheria  that  the  infectious 
material  remains  in  the  throat  for  a  long  period,  yet  it 
is  a  sensible  working  basis  in  the  present  lack  of  knowl- 
edge. It  is  not  necessary  —  in  fact,  it  is  not  desirable  — 
in  most  cases  to  close  the  public  schools.  During  the 
school  session,  which  covers  many  hours  of  the  day,  the 
children  are  not  in  condition  to  communicate  material 
from  mouth  to  mouth  except  by  the  common  drinking- 


Contagious  Diseases.  129 

cup,  and  the  exchange  of  school  pencils  and  books  which 
have  been  thumbed.  In  case  school  is  not  in  session, 
many  of  the  children  are  liable  to  come  into  close  con- 
tact in  play  for  more  hours  in  the  day.  The  failure  of 
the  disease  to  spread  in  institutions  where  hundreds  of 
children  are  bunched  together  would  not  indicate  that 
such  association  in  school  was  especially  objectionable. 

PROGNOSIS. 

Out  of  628  cases  carefully  studied  by  Lovett,  of  the 
Massachusetts  State  Board  of  Health  (as  to  the  re- 
sult of  the  paralysis),  62  (or  10.8  per  cent.)  recovered. 
Four  hundred  and  four  failed  to  recover,  61  recovered 
partially,  and  death  ensued  in  50  cases  (7.9  per  cent.). 
In  50  cases  no  report  was  given  as  to  the  result.  The 
results  appeared  in  no  way  to  be  influenced  by  the  age 
of  the  patient. 


CHAPTER  XI 
MEDICAL  INSPECTION  OF  SCHOOLS 

Among  the  diseases  known  commonly  as  "school  dis- 
eases," some  have  been  discussed  as  being  contagious, 
others  as  non-contagious;  but  all  are  to  a  greater  or  less 
extent  preventable,  either  by  discovery  and  isolation  or 
by  better  application  of  hygienic  detail.  Within  the  last 
decade,  in  the  larger  cities  of  this  country  and  Europe, 
the  plan  has  been  adopted  of  having  a  regularly  appointed 
medical  officer,  whose  duties  are  a  daily  examination  of 
all  suspected  illness,  whether  contagious  or  not ;  a  regular 
examination  of  each  child's  sight,  hearing,  and  seating; 
and  an  investigation  as  to  proper  heating  and  ventilating 
of  the  schoolroom.  At  first  some  objections  were  raised 
to  the  adoption  of  such  a  practice.  The  expense  was  de- 
plored, but  in  most  instances  the  fees  of  the  inspector 
were  fixed  at  a  merely  nominal  sum  of  one  or  two  hun- 
dred dollars  a  year.  Some  physicians  selfishly  objected, 
protesting  that  the  discovery  of  some  of  the  "school  dis- 
eases" would  serve  only  to  enlarge  the  practice  of  the 
inspector ;  but  the  rules  formulated  gave  the  inspector  no 


Medical   Inspection  of  Schools.          131 

authority  to  prescribe  medicines.  The  child  was  sent 
home  and  the  case  treated  by  the  family  physician.  Being 
a  new  thing,  it,  like  many  other  innovations  beneficial  to 
the  people,  was  looked  upon  by  some  with  little  favor. 
But  the  establishment  of  school  inspection  in  a  city  meant 
always  its  retention,  for  the  benefits  derived  were  con- 
spicuous and  the  only  wonder  was  at  the  folly  of  having 
lived  so  long  without  it. 

In  Boston,  for  the  first  fourteen  months  of  medical 
inspection,  16,700  cases  were  examined,  and  during 
that  time  were  discovered  77  cases  of  diphtheria,  28 
of  scarlet  fever,  116  of  measles,  28  of  chicken-pox, 
69  of  pediculosis  (lice),  47  of  mumps,  33  of  whooping- 
cough,  47  of  scabies  or  contagious  itch,  8  of  con- 
genital syphilis,  a  large  number  of  contagious  dis- 
eases of  the  eyes,  and  2,000  cases  of  follicular  tonsilitis. 
Following  is  the  report  of  the  health  department  of  the 
city  of  Boston  for  1900,  when  there  were  examined  by  the 
medical  inspectors  of  the  public  schools  15,573  children. 

Specific  infectious  diseases 505 

Oral  and  respiratory  diseases 2,609 

Diseases  of  the  ear 37 

Diseases  of  the  eye 431 

Diseases  of  the  skin 3>421 

Miscellaneous    diseases 3>568 

Found  free  from  disease 4>952 

15,573 


I32        The  Hygiene  of  the  Schoolroom, 

Of  the  infectious  diseases,  there  were :  diphtheria,  23 
cases;  scarlet  fever,  23;  measles,  121;  whooping- 
cough,  62;  mumps,  107;  chicken-pox,  108;  influenza,  50; 
erysipelas,  2;  syphilis,  3;  tuberculosis,  2;  malaria,  4. 
There  were  438  cases  of  acute  pharyngitis,  1,281  of  acute 
follicular  tonsilitis,  58  cases  of  adenoid  disease,  220  cases 
of  imperfect  eyesight  (without  visible  cause),  337  cases 
of  eczema,  227  of  impetigo  contagiosa,  2,316  of  pedi- 
culosis (lice,)  42  of  scabies  (itch)  ;  of  tinea  favosa  and 
tinea  trichophytina  (ring- worm),  172;  of  headache 
(habitual),  206;  of  urinary  diseases,  29. 

In  New  York  city,  during  the  first  four  days  of  medical 
inspection  in  the  public  schools,  400  cases  of  contagious 
disease  were  discovered  and  dismissed  from  school  until 
danger  from  contagion  had  passed.  The  report  of  the 
results  of  medical  inspection  of  the  public  schools  in  New 
York  city  shows  that  for  the  quarter  ending  June  30, 
1897,  there  were  220  schools  inspected  each  day  by  149 
medical  school  inspectors.  The  total  average  attendance 
was  149,520.  Of  this  number,  63,812  children  were 
examined  as  suspects,  of  whom  4,183  were  found  to  be 
affected  with  some  contagious  disease  and  excluded  from 
the  schools.  This  makes  over  six  per  cent,  of  the  total 
examined.  Of  these  cases  of  contagious  diseases,  167 
were  cases  of  diphtheria;  32  scarlet  fever;  88  measles; 


Medical  Inspection  of  Schools.          133 

ii  croup;  26  whooping-cough;  117  mumps;  702  con- 
tagious diseases  of  the  eye ;  2,627  parasitic  diseases  of  the 
head,  108  of  the  body;  130  chicken-pox;  175  skin  diseases. 

Of  the  true  cases  of  measles  and  of  scarlet  fever  all 
were  in  the  stage  oi  desquamation.  This  would  naturally 
be  the  case,  inasmuch  as  these  diseases,  in  the  beginning, 
are  marked  with  a  certain  amount  of  fever  and  discomfort 
which  leads  the  parents  to  retain  the  children  at  home, 
after  which  the  rash  appears,  and  the  case  is  then  ex- 
cluded from  the  schools.  But  there  are  certain  cases  in 
which  the  constitution  of  the  patient  is  such  that  the 
fever  is  unappreciable ;  and  the  child,  having  a  slight 
rash  only,  is  given  little  notice  by  the  parents,  and  con- 
tinues at  school  until  desquamation  occurs,  when  probably 
a  new  crop  of  cases  will  be  produced. 

To  quote  the  report :  "As  a  rule,  among  a  large  num- 
ber of  people  having  children  that  attend  school,  no 
dread  of  these  diseases,  so  common  to  childhood,  is  felt; 
and  either  through  indifference  or  selfishness  they  refuse 
to  believe  that  these  diseases  are  avoidable,  and  often 
oppose  the  use  of  the  proper  means  for  their  prevention. 

"A  glance  at  the  totals  of  the  various  diseases  for  which 
children  have  been  excluded  during  the  sixty-five  school 
days  of  the  past  three  months  shows  the  carelessness  and 
ignorance  of  many  parents  in  regard  to  the  spreading  of 


134       The  Hygiene  of  the  Schoolroom. 

infectious  and  contagious  diseases.  Not  thinking  of,  and, 
perhaps,  not  caring  about,  the  danger,  they  send  their 
children,  carrying  the  germs  of  these  diseases,  into  the 
crowded  schoolroom,  and  necessarily  expose,  and,  no 
doubt,  infect  many  other  children. 

"These  results  also  show  the  importance  of  the  med- 
ical school  inspection  as  one  means  of  preventing  the 
spread  of  these  diseases;  and  with  this  work  further  ex- 
tended and  perfected,  and  with  the  education  of  the 
parents  and  guardians  as  to  the  necessity  of  keeping  in- 
fected children  at  home,  we  shall  be  able  to  reduce  the 
number  of  these  diseases  among  the  children  of  this  city." 

In  1903,  the  first  year  of  medical  inspection  in  Provi- 
dence, R.  I.,  "1,018  children  were  found  to  be  in  an  ab-- 
normal  condition.  Three  had  diphtheria;  five,  scarlet 
fever ;  twenty-three,  German  measles ;  eighteen,  enlarged 
tonsils;  and  182  cases  of  adenoids  were  found.  In  the 
latter  cases  much  of  the  backwardness  of  the  children  is 
accounted  for,  and  in  the  discovers  of  that  malady  alone, 
say  the  physicians  there  is  sufficient  evidence  of  the  merit 
of  the  inspection,  as  by  prompt  treatment  of  the  throat 
growth  those  182  children  will  be  placed  in  a  condition 
on  a  par  with  healthy  children.  Much  also  of  the  sup- 
posed ignorance  of  the  children  will  have  been  done 
away  with,  as  that  particular  trouble  affects  greatly  the 
faculty  for  learning.  There  were  thirty-one  children 


Medical  Inspection  of  Schools.          135 

found  to  be  affected  with  ear  trouble,  seventy-two  with 
petty  eye  troubles,  and  nearly  160  with  imperfect  vision, 
133  had  skin  diseases,  ten  had  spinal  trouble,  and  five 
had  paralysis.  Twenty  were  adjudged  to  be  mentally 
deficient." 

The  Bulletin  of  the  Department  of  Health  of  Chicago, 
of  March  2,  1907,  shows  that  of  48,1 55  pupils  examined, 
7,205  or  nearly  fifteen  per  cent,  were  at  that  time  suffer- 
ing from  a  communicable  disease.  In  Massachusetts, 
during  the  school  year  of  1906-07,  out  of  an  average 
school  attendance  of  343,000,  27,342  were  reported  as 
suffering  from  diseases  and  defects  demanding  attention. 

From  statistics  gathered  from  medical  inspectors'  re- 
ports in  Berlin,  New  York,  Boston,  and  Chicago,  it  ap- 
pears that  about  six  to  fifteen  per  cent,  of  the  pupils 
attending  the  average  public  school  are  suffering  from 
some  one  or  other  of  the  diseases  enumerated,  and 
are  a  source  of  danger  to  those  with  whom  they  come  in 
contact.  The  medical  profession  has  co-operated  to  the 
extent  of  giving  its  services  at  a  very  moderate  figure: 
no  school,  then,  in  this  broad  land  should  be  without  a 
medical  officer.  It  needs  no  stretch  of  imagination  to 
believe  that  if  this  practice  is  made  general,  thousands 
of  lives  of  children  will  be  saved,  and  thousands  by  this 
protection  be  spared  the  ordeal  of  long  periods  of  illness 
and  the  enforced  loss  of  valuable  time  at  school. 


136       The   Hygiene  of  the  Schoolroom. 

Dr.  Reynolds,  health  commissioner  of  Chicago,  says 
that  he  knows  of  no  other  single  living  effort  in  which  his 
scanty  force  of  inspectors  has  engaged  that  has  been  of 
more  obvious  and  direct  benefit  to  the  community  in  gen- 
eral, as  well  as  to  the  school  children  themselves. 

In  Berlin,  after  a  serious  epidemic  of  measles  which 
paralyzed  for  a  time  the  school  system,  public  meetings 
were  held;  and  the  following  resolutions  were  adopted 
and  afterwards  put  into  practice: 

"Laymen  and  physicians  demand  that  each  school  have 
a  physician  assigned  to  it,  to  have  charge  of  the  general 
hygiene  of  the  building  and  be  watchful  over  the  health 
of  scholars;  to  see  to  the  proper  heating,  ventilation, 
cleanliness,  and,  if  necessary,  disinfection  of  the  building ; 
to  order  the  closing  of  the  school  when  the  heat  becomes 
excessive,  and  in  times  of  epidemics;  furthermore,  to 
examine  new  scholars;  in  short,  the  physicians  should 
protect  the  scholars  against  the  dangers  of  school  life." 

Dr.  Samuel  H.  Durgin,  chairman  of  the  Boston  Board 
of  Health  in  1897,  describes  the  working  of  the  system  in 
Boston.  The  Board  of  Health  divided  the  city  into  fifty 
districts,  giving  an  average  of  about  four  schoolhouses 
and  fourteen  hundred  pupils  to  each  district.  No  diffi- 
culty was  experienced  in  finding  well  qualified  and  dis- 
creet physicians  who  would  undertake  the  duties  pre- 


Medical  Inspection  of  Schools.          137 

scribed,  and  the  board  selected  and  appointed  a  physician 
for  each  district  with  a  salary  of  $200  a  year.  His  duty 
is  to  make  a  visit  to  each  master's  school  daily,  soon  after 
the  beginning  of  the  morning  session.  The  master  re- 
ceives from  the  teachers  in  his  district  early  reports  as  to 
the  appearance  of  illness  in  any  pupil  in  their  charge; 
these  reports  are  given  to  the  visiting  physician,  who  at 
once  examines  the  reported  children  and  makes  a  record 
of  his  diagnosis  and  action  in  books  furnished  by  the 
Board  of  Health  for  this  purpose  and  kept  in  the  custody 
of  the  master.  If  the  visiting  physician  finds  the  child 
too  ill,  from  any  cause,  to  remain  in  school,  he  advises  the 
teacher  to  send  the  child  home  for  the  observation  and 
care  of  its  parents  and  family  physician.  If  the  illness 
is  from  a  contagious  disease,  the  child  is  ordered  home 
and  the  case  reported  to  the  Board  of  Health.  The  dis- 
position of  the  sick  child  while  at  home  and  the  proper 
isolation  in  cases  where  contagious  diseases  develop  in 
such  children,  as  well  as  the  giving  of  a  warrant  for  re- 
turning to  the  school,  depend  principally  upon  the  report 
of  the  school  inspector. 

The  Health  Department  of  New  York  City  has  the 
best  and  most  specific  rules  for  the  medical  inspectors. 
They  are  as  follows  : 

"Inspectors  are  required  to  report  at  the  schools  to  which 


138       The  Hygiene  of  the  Schoolroom. 

they  have  been  assigned  from  8.50  to  9.30  A.  M.  every 
day  that  school  sessions  are  held.  They  are  to  examine 
carefully  each  child  that  has  been  isolated  by  the  teachers 
in  charge,  and  cause  to  be  excluded  from  school  each 
one  affected  with,  or  showing  symptoms  of,  any  con- 
tagious or  infectious  disease,  more  especially  the  follow- 
ing: measles,  diphtheria,  scarlet  fever,  croup,  whoop- 
ing-cough, mumps,  contagious  eye  diseases,  parasitic  dis- 
eases of  the  head  or  body,  or  chicken-pox.  They  shall 
furnish  each  pupil  that  is  to  be  excluded  with  a  printed 
card,  upon  which  they  shall  note  the  date,  name,  and 
location  of  the  school,  the  name,  age,  and  address  of  the 
child,  and  the  reason  for  the  child's  exclusion.  These 
cards,  signed  by  the  medical  school  inspectors,  are  to  be 
taken  home  by  the  excluded  pupils.  Each  day,  before 
leaving  a  school,  each  inspector  is  required  to  fill  out  a 
printed  daily  report  blank,  giving  the  date  and  time  of 
visit,  the  name,  location,  district  and  card  numbers  of  the 
school,  the  number  of  children  examined  (male,  female, 
and  total),  the  full  name,  age,  and  address  of  each  one 
excluded,  and  the  diagnosis  of  each  excluded  case.  Note 
is  also  to  be  made  on  the  daily  report  of  any  bacterial 
culture  that  has  been  taken,  giving  the  clinical  diagnosis, 
and  stating  whether  the  pupil  was  excluded  or  not.  On 
the  last  school  day  of  each  week,  the  printed  sum- 


Medical  Inspection  of  Schools.          139 

mary  blank,  on  the  back  of  the  daily  report  blank  used 
that  day,  is  to  be  properly  filled  out  for  each  school  day 
of  that  week.  Each  day,  as  soon  as  possible  after  leaving 
the  last  school  to  be  visited,  inspectors  are  required  to 
mail  a  separate  daily  report  (properly  folded  and 
'-backed")  for  each  school  visited,  to  the  chief  inspector 
at  the  central  office,  where  a  daily  summary  is  made  of 
the  work  performed  in  all  the  schools  visited. 

"All  children  excluded  from  school  for  measles  or  scar- 
let fever  are  visited  at  their  homes  within  twenty-four 
hours  by  one  of  the  diagnosticians  of  the  board,  and  such 
cases  are  not  tabulated  as  true  ones  unless  he  confirms 
the  diagnosis,  when  a  department  postal  card  is  sent  to  the 
school,  excluding  the  child  until  after  his  complete  re- 
covery. When  the  necessary  disinfection  and  fumigation 
of  the  rooms  where  the  child  lives  have  been  attended 
to,  a  certificate  allowing  him  to  return  to  school  is  issued. 

"Pupils  excluded  for  chicken-pox  are  visited  at  their 
homes  by  the  medical  inspectors  of  the  Division  of  Con- 
tagious Diseases  having  charge  of  the  districts  in  which 
the  children  live;  when  they  confirm  the  diagnosis,  the 
cases  are  recorded  as  true  ones,  and  the  schools  notified 
by  department  postal  cards. 

In  cases  of  suspected  diphtheria,  when  there  is  well- 
marked  clinical  evidence  in  the  throat  at  the  time  of  the 


14°       The  Hygiene  of  the  Schoolroom. 

examination,  the  child  is  to  be  excluded,  after  a  culture 
has  been  taken;  when  the  clinical  evidence  is  not  well- 
marked,  a  culture  is  to  be  taken,  but  the  child  is  not 
to  be  excluded  until  a  report  is  received  by  the  medical 
school  inspector  from  the  Division  of  Bacteriology,  stat- 
ing that  an  examination  of  the  culture  shows  the  presence 
of  the  Klebs-Loeffler  bacilli.*  In  each  case  where  an  ex- 
amination of  a  culture  taken  by  a  medical  school  inspector 
shows  the  presence  of  the  Klebs-Loeffler  bacilli,  a  notice 
to  that  effect  is  promptly  mailed  to  the  maker  of  the  cult- 
ure, and  also  to  the  medical  inspector  of  the  Division  of 
Contagious  Diseases  in  whose  district  the  child  resides, 
who  then  takes  charge  of  the  case  as  far  as  the  proper 
isolation  is  concerned,  taking  subsequent  necessary  cult- 
ures, ordering  disinfection  and  fumigation  when  the 
Klebs-Loeffler  bacilli  have  disappeared  from  the  throat, 
and  issuing  certificates  for  the  child's  return  to  school. 

"The  district  medical  inspectors  have  the  same  surveil- 
lance over  each  case  of  measles  or  scarlet  fever  where  the 
diagnosis  made  by  the  school  inspector  has  been  con- 
firmed by  a  diagnostician.  When  the  result  of  an  ex- 
amination of  a  culture,  made  by  a  school  inspector,  is 
negative,  a  report  to  that  effect  is  forwarded  to  the  chief 


*  The  Klebs-Loeffler  bacilli  is  the  germ  that  is  the  recognized  cause  of  diphtheria. 


Medical  Inspection  of  Schools.         141 

inspector,  but  not  to  the  maker  of  the  culture.  When  the 
examination  of  a  culture  made  by  a  school  inspector  does 
not  admit  of  an  exact  bacteriological  diagnosis,  and  a 
prompt  confirmatory  culture  is  requested,  such  request  is 
mailed  to  the  maker  of  the  culture,  and  also  to  the  district 
medical  inspector,  in  order  that  a  confirmatory  culture 
may  be  taken  by  the  former,  if  the  child  is  at  school,  or 
by  the  latter,  if  the  child  should  be  at  home.  All  cultures 
made  by  the  school  inspectors,  accompanied  by  the  'cult- 
ure blanks,'  properly  filled  out  and  signed,  should  be 
promptly  forwarded  to  the  nearest  culture  station. 

"Children  excluded  on  account  of  whooping-cough, 
mumps,  contagious  eye  diseases,  parasitic  diseases,  etc., 
should  be  told  to  return  when  cured,  and  should  be  again 
examined  before  returning  to  their  classrooms ;  if  not 
entirely  well  they  should  be  again  excluded. 

"The  inspectors  are  required  to  ascertain  from  princi- 
pals and  teachers  the  names  and  addresses  of  all  children 
from  homes  where  there  are  contagious  diseases,  if  notifi- 
cation has  not  been  sent  to  the  schools  by  the  Board  of 
Health;  and  such  lists  are  forwarded  with  the  daily  re- 
ports. Inspectors  keep  daily  records  in  blank-books,  fur- 
nished for  such  purpose,  of  the  number  of  children  ex- 
amined (male,  female,  and  total),  the  full  names,  ages, 
residences,  and  causes  for  exclusion  of  those  excluded 
from  school,  and  a  list  of  cultures  taken  and  forwarded. 


142       The  Hygiene  of  the  Schoolroom. 

"If,  by  reason  of  illness  or  other  cause,  an  inspector  is 
unable  to  report  at  a  school,  arrangements  must  be  made 
with  an  inspector  of  another  school  to  act  as  a  substitute, 
and  the  chief  inspector  informed  of  the  facts  without  un- 
necessary delay. 

"If,  in  the  opinion  of  an  inspector,  immediate  action 
should  be  taken  by  the  Board  of  Health  in  any  case,  he 
immediately  communicates  by  telephone  with  the  chief 
inspector.  Medical  school  inspectors  report  at  the  central 
office  once  during  each  month.  Exclusion  cards  for  pu- 
pils, daily  report  blanks,  addressed  envelopes,  blank-books 
for  recording  the  work  performed,  wooden  tongue  de- 
pressors, culture  outfits,  and  lists  of  culture  stations,  are 
furnished  at  the  office  of  the  chief  inspector. 

"The  daily  duties  of  medical  school  inspectors  cease 
when  they  have  mailed  their  reports,  after  leaving  their 
schools.  They  are  not,  under  any  circumstances,  to  visit 
children  at  their  homes,  to  prescribe  for  them,  or  suggest 
treatment  at  the  schools.  The  treatment  must  be  received 
from  the  family  physicians,  in  the  dispensaries,  or  in  the 
hospitals." 


NOTE.  After  the  necessary  disinfection  and  fumigation  of  the  rooms  in  which  there 
has  been  an  infectious  or  contagious  disease,  postal  cards  are  mailed  by  the  Division  of 
Contagious  Diseases,  notifying  the  proper  schools  that  it  is  safe  to  readmit  the  child  or 
Children  living  in  those  rooms. 


Medical  Inspection  of  Schools.         143 

There  should  be  no  opposition  from  the  parents,  on 
the  ground  of  interference  with  the  child's  liberty ;  on  the 
contrary  they  should  be  pleased  to  know  that  their  child 
is  daily  under  a  trained  eye  of  a  person  who  can  more 
readily  detect  the  onset  of  disease  than  they  can,  and 
whose  only  duty  is  to  separate  the  infected  child  from  his 
fellows,  both  for  his  own  good  and  the  good  of  the  whole. 
Then,  too,  it  must  not  be  forgotten  that  disease  will  be 
earlier  detected  in  its  course  and  treatment  begun  at  a 
more  opportune  time  and  with  far  better  results. 

Under  a  perfect  system  the  inspector  will  have  mani- 
fold responsibilities.  His  duties  will  embrace  regular 
examination  of  the  eyes  and  ears.  In  this  particular 
alone  he  will  forestall  measureless  sufferings  and  thanks 
to  him  these  organs  will  be  preserved  for  a  more  useful 
future.  By  this  same  system  of  inspection  he  will  avert 
many  cases  of  spinal  distortion  and  stooped  shoulders,  by 
seeing  that  each  pupil  is  assigned  a  seat  and  a  desk  that 
is  fitted  to  him  and  comfortable  to  use.  Everything  in 
the  building  that  relates  to  its  hygiene  should  be  under 
his  watchful  eye.  The  heating,  the  temperature,  the 
ventilation,  the  disinfection,  and  the  sanitary  closets 
would  then  be  supervised  by  one  competent  to  know  the 
exact  requirements  of  all  these  departments. 


144       The   Hygiene  of  the  Schoolroom. 

The  school  authorities  outside  the  principal  cities  of  our 
country  have  been  slow  to  make  use  of  the  great  ad- 
vantages of  medical  inspection.  It  is  not  a  fad, — it  is  an 
ideal  application  of  the  "ounce  of  prevention."  No 
school  is  too  large  for  its  scope  and  none  so  small  that  it 
can  dispense  with  it.  It  is  a  safe  prediction  that  another 
decade  will  find  the  practice  general.  Delay,  therefore, 
in  instituting  the  regular  inspection  of  schools  is  not 
wise ;  it  is  better  to  be  a  leader  in  a  good  movement,  no 
matter  how  unpopular  the  movement  may  be  at  first,  than 
to  be  dragged  into  it  later  from  fear  of  the  shame  of 
standing  opposed  to  public  good. 


NOTE.  —  Medical  inspection  was  primarily  established  for  the  discovery  and  preven- 
tion of  communicable  diseases,  but  no  small  part  of  its  effectiveness  has  been  its  effect 
in  non-communicable  diseases,  as  the  following  record  of  children  examined  in  New 
York  city  from  March  28  to  December  23,  1907,  will  show  : 

Number  of  children  examined 55>332 

Cases  of  bad  nutrition 3.823 

Anterior  cervical  glands 14.214 

Posterior  cervical  glands 3,047 

Chorea 738 

Cardiac  disease 895 

Pulmonary  disease 600 

Skin  diseases 989 

Deformity  of  spine 485 

Deformity  of  chest 401 

Deformity  of  extremities 498 

Defective  vision "6,394 

Defective  hearing i,20 

Defective  nasal  breathing 6,182 

Defective  teeth 18,182 

Defective  palate 689 

Hypertrophic  tonsils 8,347 

Posterior  nasal  growths 5i>i«9 

Defective  mentality 1,210 

Number  of  cases  treated. 33>55' 


CHAPTER  XII 
MODERN  EDUCATION  AND  HEALTH 

If  one  were  to  take  note  of  the  physical  condition  of 
children  entering  school,  and  again  of  the  same  children 
graduating  from  the  high  school,  it  would  be  found  that 
many  had  suffered  physical  deterioration  by  this  edu- 
cating process. 

The  brain  has  been  improved  and  developed  and  the 
body  allowed  to  care  for  itself.  If  the  school  work  lags 
behind,  if  the  brain  works  badly,  there  are  the  teacher, 
the  principal,  and  the  superintendent  to  be  consulted  about 
it — yes,  even  the  parent  receives  notification  that  the 
child's  work  is  not  up  to  the  standard.  If  the  bodily 
strength  is  not  up  to  par,  who  cares?  If  the  cheeks  of 
the  little  one  fade  day  by  day,  and  the  shoulders  become 
more  stooped  and  the  chest  more  hollowed,  who  is  noti- 
fied? Again,  the  child  may  keep  the  school  work  up  to 
the  standard,  perhaps  be  the  star  pupil,  and  yet  be  poorly 
nourished,  pale,  sickly  and  undersized.  No  one  regulates 
the  amount  of  work  to  be  done;  the  brain  is  stuffed 
while  the  remaining  organs  of  the  body  are  starving. 


146       The  Hygiene  of  the  Schoolroom. 

Spurred  on  by  teacher  and  parent,  who  see  no  limit  to 
human  endurance,  the  infant  prodigy  is  developed  and 
finally  goes  the  way  of  all  infant  prodigies. 

Every  physician  knows  that  his  family  practice  annually 
brings  cases  worn  down  by  school  work.  The  major 
share  of  the  cases  is  found  among  the  girls,  who  usually 
are  more  serious  students  than  the  boys,  and  do  not  enjoy 
the  invigorating  exercises  of  the  latter. 

Dr.  S.  Weir  Mitchell,  than  whom  there  is  none  better 
qualified  to  speak  on  this  subject,  says:  "I  believe  that, 
as  concerns  the  future  of  our  women,  they  would  do  far 
better  if  they  were  more  lightly  taxed,  and  the  school 
hours  but  three  or  four  a  day  until  they  reached  the  age 
of  seventeen.  Anything,  indeed,  would  be  better  than  the 
loss  of  health,  and  if  it  is  a  question  of  doubt,  the  school, 
unhesitatingly,  should  be  abandoned  or  its  hours  greatly 
lessened,  as  it  is  at  least  in  part  the  source  of  very  many  of 
the  nervous  maladies  with  which  our  women  are 
troubled. 

"Overwork  of  the  brain  is  a  serious  evil  to  women  at  the 
age  of  womanly  development,  when  the  nervous  system  is 
so  sensitive  and  irritable,  and  at  no  other  time  is  an 
abundant  supply  of  fresh  air  and  exercise  so  important. 
The  American  woman  to-day  is  perhaps,  of  all  civilized 
females,  the  least  qualified  to  undertake  the  weighty  tasks 


Modern  Education  and  Health.         147 

which  tax  the  nervous  system  of  women.  How  few 
mothers  are  there  to-day,  in  the  higher  educated  class  of 
women,  who  have  rushed  through  college  and  played  the 
devotee  to  fashion  and  society  that  can  nurse  their  off- 
spring !" 

Dr.  W.  W.  Potter,  in  his  address  as  President  of  the 
Medical  Society  of  the  State  of  New  York,  said:  "The 
years  between  ten  and  fourteen  are  full  of  import  for  a 
girl :  during  them  she  lays  the  foundation  for  future 
weal  or  woe,  and  I  hesitate  not  to  declare  that  this  is  a 
period  of  infinite  responsibility  for  mothers,  perhaps  the 
greatest  of  any  part  of  the  educational  life  of  their  girls. 
Many  girls  begin  their  new  physiological  life  at  the  age 
of  twelve ;  but,  if  they  should  not  do  so  quite  as  early,  this 
is  still  a  period  when  nature  is  making  preparations  for  a 
new  existence  for  the  young  female,  and  if  her  plans  are 
interfered  with  or  thwarted,  even  in  their  smallest  details, 
years — long,  sorrowing  years,  perhaps — of  pain  and  suf- 
fering and  woe  are  sacrificed  to  the  shrine  of  ignorance 
or  wilful  neglect.  The  scholastic  training  of  girls  is 
being  carried  on  with  its  greatest  vigor  at  the  very  time 
when  they  are  physically  least  suited  to  bear  the  strain. 
Just  when  the  ovary  is  beginning  to  require  a  large  ex- 
penditure of  nerve  force,  the  brain,  under  our  present 
system,  is  demanding  all  that  an  active  cerebration  can 
produce,  and  oftentimes  even  more. 


148       The  Hygiene  of  the  Schoolroom. 

"I  am  heartily  in  favor  of  the  higher  education  ot 
women,  but  am  thoroughly  opposed  to  the  present  system 
of  female  education.  Too  much  is  attempted  in  the  time 
allowed  in  preparatory  schools.  It  were  far  better  to 
have  fewer  studies  thoroughly  comprehended,  than  to 
attempt  to  cram  with  a  number  that  can  only  be  super- 
ficially acquired  in  the  time  allotted  to  them.  Notice 
some  of  the  star  pupils  who  have  been  'prepared'  for 
exhibition.  That  girl  is  a  'bright'  scholar.  She  is  a 
chronological  almanac,  and  can  tell  every  date  in  English 
history  from  Caesar's  Invasion,  or  tell  of  all  the  battles 
the  world  has  known  and  the  number  of  the  fallen;  will 
tell  you  in  an  instant  if  one  pipe  empties  a  pond  in  seven 
hours  and  another  in  four,  just  how  long  it  will  take 
two  to  do  it.  She  will  lead  you  at  a  lively  pace  through 
the  labyrinth  of  compound  restrictive  clauses  with  parrot- 
like  precision,  but  it  is  simply  mental  discipline ;  a  simple, 
real,  face-to-face  problem  will  cause  her  to  falter  and 
stumble." 

The  present  generation,  taking  heed  to  the  hundreds  of 
physicians  who  have  decried  present  educational  methods 
and  their  physical  results,  is  just  beginning  to  show  faint 
signs  of  Improvement.  But  even  yet  there  are  too  manv 
schools,  both  private  and  public,  conducted  along  the 
same  line  as  Dr.  Blimber's  school,  described  by  Dickens  in 
Dombey  and  Son. 


Modern  Education  and  Health.         149 

"Dr.  Blimber's  establishment  was  a  great  hothouse  in 
which  there  was  a  forcing  apparatus  constantly  at  work. 
Mental  green  peas  were  produced  at  Christmas,  and  intel- 
lectual asparagus  all  the  year  round.  Nature  was  of  no 
consequence  at  all;  no  matter  what  a  young  gentleman 
was  intended  to  bear,  Dr.  Blimber  made  him  bear  to  order 
somehow  or  other.  This  was  very  pleasant  and  ingenious, 
but  the  system  of  forcing  was  attended  with  its  usual 
disadvantages ;  there  was  not  a  right  taste  about  the  pre- 
mature productions,  and  they  didn't  keep  well.  .  .  . 
And  people  did  say  that  the  doctor  had  rather  overdone  it 
with  young  Tcots,  who,  when  he  had  whiskers,  left  off 
having  brains." 

Savage  nations  have  always  held  education  in  small 
favor,  finding  by  experience  that  the  school  acted  badly  on 
the  bodily  health  of  their  children.  Dr.  J.  H.  Kellogg, 
of  Battle  Creek,  Michigan,  cites  an  example  of  personal 
observation  that  emphasizes  well  this  point: 

"Some  years  ago,  while  spending  a  short  time  among 
the  Yuma  Indians,  in  the  vicinity  of  old  Fort  Yuma,  Ari- 
zona, I  observed  one  morning  a  considerable  number  of 
old  warriors  and  chiefs  gathering  in  from  the  forest  and 
collecting  in  the  old  fort.  Upon  inquiring  I  found  there 
was  to  be  an  Indian  school-meeting,  the  first  one  ever 
held  among  the  Yumas. 


150       The  Hygiene  of  the  Schoolroom. 

"The  school  had  been  started  some  two  years  before  by 
Sister  Alphonse  and  two  or  three  other  devoted  Catholic 
sisters,  who  had  ventured  into  the  wilds  of  Arizona  to 
undertake  the  experiment  of  educating  the  Yuma  boys 
and  girls ;  but  their  school  had  not  prospered.  The  chil- 
dren had  been  kindly  treated ;  they  had  been  supplied  with 
an  abundance  of  food,  whereas  before  they  were  often 
hungry ;  they  had  been  furnished  with  clothing,  including 
hats,  bonnets,  shoes  and  stockings,  whereas  before  they 
had  roamed  the  forest  in  nakedness.  The  schools  were 
furnished  with  all  the  necessary  modern  appliances  and 
the  teachers  labored  earnestly  in  behalf  of  the  students. 

"Nevertheless,  Sister  Alphonse  confessed  to  me  that  the 
school  was  not  a  success,  and  that  the  old  Indians  were 
very  much  opposed  to  it.  I  inquired  the  reason  for  their 
opposition,  and  was  told  that  the  Indians  complained  that 
going  to  school  did  not  agree  with  the  health  of  their 
children ;  that  after  having  been  in  school  a  few  months 
they  were  far  less  robust  and  vigorous  than  before,  and 
that  they  suffered  from  indigestion,  catarrh,  and  other 
diseases,  from  which  they  were  before  as  free  as  the 
birds,  the  antelopes,  and  the  prairie  dogs  among  which 
they  lived.  The  good  sisters  honestly  admitted  that  the 
complaint  of  the  old  Indians  was  not  without  foundation 
and  that  it  was  true  that  for  some  reason  the  little  wild 


Modern  Education  and  Health.         151 

children  of  the  forest  began  to  lose  their  vigor  and 
vivacity  soon  after  entering  school,  and  therefore  some  of 
the  most  sagacious  parents  had  kept  their  chidren  at 
home. 

"The  school  meeting  had  been  called  for  the  purpose 
of  presenting  to  the  old  Indians  the  advantages  of  an 
education,  so  as  to  convince  them,  if  possible,  that  the 
children  would  better  have  an  education  even  if  the  get- 
ting of  it  should  spoil  their  stomachs,  weaken  their  lungs, 
destroy  their  keen  sense  of  smell  through  catarrh,  impair 
their  eyesight,  dull  their  hearing,  and  deprive  them  of  the 
hardihood  which  had  enabled  them  for  centuries  to  main- 
tain the  independence  which  they  still  possessed. 

"I  did  not  remain  to  hear  the  conclusion  of  the  matter, 
but  a  few  years  later,  in  passing  through  the  country  on 
a  visit  to  the  Pacific  Coast,  I  spent  a  day  among 
the  same  Indians.  I  found  the  school  flourishing,  to 
the  great  delight  of  the  good  sisters,  but  the  children 
perishing.  Their  forest  air  of  rollicking  freedom  had  dis- 
appeared, and  the  evidences  of  physical  depression  and 
deterioration  were  unmistakably  apparent.  Civilization 
had  conquered,  and  the  Indians  had  become  convinced 
that  their  children  must  be  educated  even  at  the  expense 
of  health  and  vigor." 

With  such  undeniable  proof  of  the  unhealthy  drift  of 


I52        The   Hygiene  of  the  Schoolroom. 

modern  school  methods,  we  should  study  to  find  the  causes 
and  remedies  of  the  effects  produced. 

School  children  are  prone  to  suffer  from  anaemia,  in- 
digestion, headache  and  neuralgia,  insomnia,  nervousness, 
chorea,  and  fatigue.  Anaemia  is  a  condition  visible  as 
a  great  pallor  of  the  skin  and  weakness.  It  is  the  com- 
mon complaint  when  a  child  is  spoken  of  as  being  "run 
down."  It  is  usually  persistent  in  its  course,  appearing 
most  often  in  girls,  and  sometimes  is  the  herald  of  a  life- 
time of  weakness  and  invalidism.  Lack  of  exercise,  too 
much  confinement,  and  improper  nourishment,  are  the 
commonest  causes.  Indigestion  sometimes  appears  alone 
or  accompanied  by  anaemia,  and  has  usually  the  same 
causes.  Headache  and  neuralgia  claim  many  sufferers 
of  school  age,  and  are  attributable  to  poorly  ventilated 
rooms,  over-study,  eye-strain,  and  fatigue.  Insomnia  is 
most  often  noted  among  school  children  who  worry  es- 
pecially over  keeping  up  the  work,  or  about  examination 
time,  when  the  brain  becomes  over-taxed. 

Chorea,  or  St.  Vitus  Dance,  is  common  in  school  life. 
It  consists  of  irregular,  involuntary  contraction  of  mus- 
cles, sometimes  with  slight  mental  disturbances.  At 
times  the  muscles  of  the  face  or  neck,  or  the  head  itself, 
may  twitch,  producing  horrible  grimaces.  It  may  be 
hereditary  or  be  the  result  of  exhaustive  drains  on  the 


Modern  Education  and  Health.         153 

nervous  system  from  school  work.  Immediately,  when 
this  trouble  is  recognized,  the  child  should  be  removed 
from  school  for  his  own  sake,  for  the  quiet  it  secures,  and 
for  the  good  of  the  remaining  pupils.  Careful  observers 
have  traced  cases  that  were  caused  by  children's  imitating 
the  movements  of  a  real  sufferer.  The  disease  lasts  in 
mild  cases  about  ten  weeks ;  in  others  six  months  or  more. 
The  child  should  not  be  returned  until  after  a  physician 
has  pronounced  the  disease  entirely  cured,  as  in  numerous 
cases  too  early  return  to  school  is  followed  by  relapse. 
When  hysteria  is  encountered  at  school  the  victim  should 
be  placed  in  a  quiet  room  and  left  absolutely  alone.  Sym- 
pathy or  attention  from  those  around  serves  only  to  in- 
tensify the  attacks. 

Nervousness,  the  American  national  disease,  is  a  hyper- 
excitability  of  the  nerves,  which  shows  itself  in  various 
forms.  The  most  prominent  symptoms  are  twitching  of 
muscles,  convulsive  movements,  drowsiness,  headache,  ir- 
ritability, great  restlessness,  unexplainable  fears,  inde- 
cision, and  inability  to  concentrate  thought  for  any  great 
period  of  time.  In  many  cases  it  is  hereditary,  and  in 
other  cases  acquired.  If  it  be  true  that  nervousness  and 
its  grown-up  brother,  nervous  prostration,  are  so  typically 
American,  it  would  be  national  wisdom  to  find  out  how  far 
they  are  caused  by  school  work,  and  to  attempt  to  cut  them 


154       The   Hygiene  of  the  Schoolroom. 

off  ere  they  have  driven  their  roots  into  the  very  ground- 
work of  the  child's  constitution.  To  begin  with,  chil- 
dren are  sent  to  school  too  young  for  serious  study.  The 
kindergarten  should  receive  children  from  four  to  seven 
years  old.  At  seven  years  of  age,  at  least  no  earlier  than 
six,  the  real  primary  work  may  commence  with  the 
normal  child.  But  if  a  child  be  backward  in  development, 
either  mental  or  physical,  his  entrance  into  school  should 
be  delayed. 

With  children  from  six  to  ten  years  of  age  there  should 
be  two  sessions  of  no  greater  length  than  an  hour  and  a 
half  each;  from  ten  to  fourteen,  two  sessions  of  one  and 
three-quarters  hours  each ;  and  for  the  remainder  in  public 
schools,  two  sessions  of  two  hours  each. 

All  medical  men  who  have  studied  the  school  question 
hygienically  have  pronounced  the  school  hours  too  long, 
and  have  proved  that  just  as  good  results  can  be  got 
from  the  plan  of  reduced  hours  as  from  the  plan  in  prac- 
tice to-day — even  better  intellectual  and  indubitablv  better 
physical  results. 

"Mr.  Charles  Paget,  formerly  M.  P.  for  Nottingham, 
England,  once  tried  in  the  village  school  on  his  estate 
at  Ruddington  a  very  interesting  experiment.  He  was 
not  satisfied  with  the  general  progress  made  by  the  boys, 
and  he  provided  for  them  a  large  garden.  The  school 


Modern   Education  and   Health.         155 

was  then  divided  into  two  similar  sections,  one  of  which 
was  kept  to  the  ordinary  school  work  for  the  ordinary 
hours,  the  other  for  half  of  these  hours  only,  the  rest 
of  the  school  time  being  devoted  to  work  in  the  garden. 
At  the  end  of  the  term  the  half-time,  or  gardening,  boys 
had  excelled  the  others  in  every  respect;  in  conduct,  in 
diligence,  and  in  the  results  of  study." 

This  illustration  is  not  overdrawn,  nor  at  all  hard  to 
explain.  A  similar  experiment  was  tried  in  this  country 
in  a  school  in  which  the  girls  at  first  excelled  the  boys. 
The  boys  were  sei  free  to  play  during  one-half  the  former 
school  hours.  The  result  was  that  the  boys  soon  over- 
took and  excelled  the  girls. 

If,  then,  better  work  is  obtainable  in  half  the  time, 
where  is  the  wisdom  of  such  long  hours  ?  Buf ,  the  answer 
comes,  we  have  the  schools  and  the  teachers  at  our  service, 
and  in  many  cases  the  mother  is  glad  for  the  time  being 
to  have  the  child  cared  for  and  her  own  burdens  made 
lighter.  All  true  enough,  but  too  little  reason  for  the 
child's  confinement  when  health  is  in  danger. 

In  communities  where  great  crowding  is  the  rule,  and 
schools  are  opened  in  basements  and  every  other  available 
space,  it  would  be  far  wiser  to  have  relays  of  pupils  in 
the  regular  school  buildings.  For  instance,  just  as  good 
results  would  be  accomplished  by  having  the  first  division 


156       The  Hygiene  of  the  Schoolroom. 

come  to  school  at  9  A.  MV  remain  until  10.30  A.  M.,  and  be 
dismissed.  At  the  latter  hour  school  would  then  begin 
for  the  second  division  and  continue  until  12  M.  At 
1.30  P.  MV  the  first  division  would  reassemble  and  work 
until  3  P.  M._,  when  the  last  session  of  the  second  division 
would  begin,  lasting  until  4  p.  M.  In  this  manner  double 
the  ordinary  number  could  be  housed  and  under  better 
conditions  than  temporary  quarters  could  provide. 

The  assignment  of  work  to  pupils,  it  is  hoped,  will  some 
day  be  radically  changed.  As  a  measure  of  economy,  the 
ordinary  school  is  now  divided  into  two  or  more  classes. 
The  pupils  of  each  class,  without  regard  to  their  capacity, 
are  supposed  to  keep  up  with  the  work  of  their  fellow 
pupils.  It  is  true  that  the  allotment  of  special  work  to 
each  individual  child  would  multiply  the  work  of  the 
teacher;  yet  this  plan  deserves  serious  consideration.  In 
industrial  life  it  has  always  proved  impossible  for  a  num- 
ber of  men  to  accomplish  equal  amounts  of  "piece  work" 
unless  the  required  amount  is  a  very  low  one,  so  low  as 
to  be  far  below  the  ability  of  a  great  many.  The  same  is 
true  in  school  work.  If  an  amount  of  work  is  allotted 
sufficient  for  the  dull  ones,  it  will  be  a  too  easy  task  for 
the  brighter  ones.  The  standard  of  work  is  therefore 
set  high,  and  many  are  dragged  along,  doing  more  than 
their  brain  power  should  allow,  and  actually  suffering 


Modern  Education  and  Health.         157 

from  the  study  imposed.  Ideal  conditions  will  only  be 
found  when  the  right  measure  of  a  child's  capacity  can 
be  found  and  the  required  work  can  be  made  com- 
mensurate with  it. 

In  America  to-day  all  roads  lead  to  specialization :  the 
old-time  general  education,  which  was  a  conglomerate 
cramming,  an  educational  potpourri,  is  fast  giving  away 
to  specialties.  The  high  schools  and  the  colleges  all  have 
courses  leading  to  definite  departments  of  life  without 
taking  on  the  many  useless  frills.  So,  also,  the  work  in 
the  lower  schools  should  be  shorn  of  all  that  is  useless. 
It  is  better  that  proficiency  be  attained  in  a  few  studies 
than  to  have  a  smattering  of  all. 

Home  study  should  be  recommended  only  when  abso- 
lutely necessary,  and  if  the  child's  physique  is  below  par, 
not  at  all.  For  children  below  the  age  of  twelve,  the 
hours  at  school,  if  used  to  the  best  purpose,  take  all  of  the 
time  in  which  the  brain  should  be  used,  and  the  additional 
home  work,  which  is  most  often  done  at  night,  and  by 
artificial  light,  destroys  much  of  the  bodily  energy  which 
could  be  used  more  advantageously.  The  same  is  true  of 
the  "extras,"  such  as  music,  painting,  and  needlework. 
Many  a  growing  girl  is  unable  to  stand  the  double  strain 
of  arduous  school  duties  followed  by  hours  of  practice  in 
accomplishments  forced  upon  her  by  proud  parents.  The 


158       The  Hygiene  of  the  Schoolroom. 

parent  is  the  true  arbiter  of  the  question,  and  if  the  "ac- 
complishments" must  be  had,  the  time  allotted  for  them 
should  not  be  so  great  as  to  interfere  with  the  regular 
school  work.  Dr.  Halle  of  Berlin  states  that  out  of  every 
one  thousand  young  girls  who  begin  to  learn  the  piano 
before  they  are  fourteen,  six  hundred  are  affected  by 
some  kind  of  nervous  disease,  while  out  of  one  thousand 
other  girls  who  are  not  taught  the  piano  only  one  hun- 
dred suffer  in  a  like  manner.  The  doctor  recommends 
that  the  study  of  the  piano  should  not  begin  until  after 
the  age  of  sixteen. 

It  is  not  proper  treatment  to  keep  a  dull  child  after 
school  for  inefficiency.  He  may  be  one  who  has  tried 
hard  and  is  unable  to  come  up  to  the  standard.  To  keep 
him  after  school  will  surely  make  him  duller.  The 
school  course  should  be  a  flexible  one,  and  no  tasks 
should  be  given  to  any  pupil  which  he  cannot  accomplish 
during  ordinary  school  hours. 

Many  pupils  are  able  to  keep  up  with  their  classes  by 
dint  of  hard  work,  but  find  when  examination  time  comes 
that  the  extra  labor  incident  to  review  is  too  great.  Then 
they  succumb.  More  pupils  suffer  from  headache, 
fatigue,  and  nervousness,  at  the  time  of,  and  after  exam- 
ination, than  at  any  other  period  of  the  school  year.  For 
this  reason  many  are  now  wisely  pleading  for  the  abolition 


Modern   Education  and   Health.         159 

of  completive  examination  as  being  useless  and  as  expos- 
ing the  pupil  to  physical  harm.  This  reform  could  be 
carried  through  without  loss  to  school  work. 

All  of  the  many  enumerated  causes,  either  singly  or 
combined,  lower  the  force  of  the  nervous  and  muscular 
system :  the  brain  power  is  at  a  low  ebb  and  physical 
strength  also  suffers.  This  is  the  state  spoken  of  as 
fatigue.  In  this  condition  the  child  has  not  one-tenth 
of  his  normal  power,  his  ability  to  concentrate  is  poor, 
and  his  retention  is  almost  nil.  In  such  cases  a  long  pe- 
riod of  rest  from  the  school  is  advised.  With  milder 
cases,  a  lessening  of  the  work,  with  opportunities  for 
physical  building  up,  will  suffice. 

The  lessons  should  be  short;  when  long,  there  should 
be  pauses  between.  Best  attention  in  school  can  be  had 
during  the  opening  hour  of  the  morning,  as  the  child's 
mind  is  then  in  best  condition  for  work.  Too  often  this 
valuable  hour,  which  should  be  devoted  to  the  most  diffi- 
cult studies,  is  given  to  miscellaneous  exercises,  interest- 
ing, it  is  true,  but  better  adapted  to  a  later  hour  in  the 
morning,  when  fatigue  has  already  made  itself  apparent. 
The  best  hours  for  school  work  are  from  8  to  10.15 
A  M.  ;  the  worst  hour  is  from  n  to  12.  From  i  to  2.30 
p.  M.  is  the  third  best,  and  from  3  to  4  the  second  best. 
Kemsies  says  the  studies  he  found  to  be  most  fatiguing  in 
order  were :  gymnastics,  mathematics,  foreign  languages, 
religion,  mother  tongue,  natural  history,  geography,  his- 


i6o       The  Hygiene  of  the  Schoolroom. 

tory,  singing,  and  drawing.  In  Paris,  at  the  Lycee,  the 
Minister  of  Education  allowed  a  teacher  to  change  the 
order  of  the  work  to  accord  more  with  his  idea  of  the 
pupil's  ability,  and  found  that  the  work  that  usually  re- 
quired seven 'years  was  as  well  done  in  three  and  one- 
half.  Lastly,  the  greatest  enemy  to  fatigue  was  the  old- 
fashioned  recess,  where  the  children  were  allowed  ten  or 
fifteen  minutes  of  play.  Teachers  complained  that  this 
recess  got  the  pupil's  mind  off  the  work.  This  is  the 
simplest  and  best  argument  in  its  favor. 

In  order  to  present  a  clear  mind  for  school  work  in  the 
morning,  it  is  very  essential  that  a  child  have  the  requisite 
amount  of  sleep  for  one  of  his  age. 

The  average  amount  of  sleep  required  at 
4  years  old  is  12  hours. 

7       "       "     "    ii       " 

9  "  "  "  ioy2  " 
12-14  "  "  "  9-io" 
14-21  "  "  "  9  " 

It  will  be  difficult  to  attain  to  the  ideal  at  once,  but  ad- 
herence to  these  suggestions  widl  go  a  long  way  towards 
giving  better  bodies  to  our  school  children,  probably  with 
no  loss  to  the  mental  faculties.  It  is  useless  to  store  a 
beautiful  mind  in  an  unhealthy  body.  The  real  education 
is  a  healthy  combination  of  good  mind  and  good  body, 
for,  as  Paley  says,  "It  is  every  preparation  that  is  made 
in  our  youth  for  the  sequel  of  our  lives." 


CHAPTER  XIII 
SCHOOL  DIET 

The  subject  matter  of  the  present  chapter  has  greater 
interest  for  boarding  schools  than  for  public  schools.  In 
the  latter,  however,  it  should  be  a  subject  for  investigation 
by  the  teacher,  that  she  may  be  able  to  instruct  the  pupils 
as  to  what  foods  and  what  quantities  are  most  suitable 
during  school  life,  when  physical  and  mental  growth  are 
most  exacting  in  their  demands. 

Parents,  ordinarily,  manifest  little  concern  in  the  diet 
of  the  child,  offering  the  same  foods  to  one  of  tender  age 
as  are  offered  to  the  robust  workingman.  The  excuse  in 
many  cases  is  that  with  moderate  means  it  is  well-nigh 
impossible  to  present  a  great  variety,  and  economy  forces 
all  the  members  of  the  family  to  partake  of  the  same 
eatables.  Fortunately,  this  is  false  reasoning,  for  it  is 
the  truth  that  the  most  nutritious  foods  are  those  of  least 
cost.  Advocates  of  particular  dietary  fads,  such  as  ex- 
clusively vegetable  food,  are  not  to  be  heeded,  for  experi- 
ence has  taught  that  with  the  school  child  a  wise  variety 
combining  proper  admixture  of  animal  and  vegetable 


1 62       The  Hygiene  of  the  Schoolroom. 

food  is  the  most  desirable.  The  proportion  of  meat  at 
all  meals  for  children  should  be  small,  preference  being 
given  to  the  so-called  physiological  food  for  children, 
cereals,  vegetables  and  milk.  Many  parents  of  means 
are  ignorant  of  these  matters,  and  short  talks  by  the 
teacher  to  the  pupil  will  be  productive  of  great  good. 

Many  diseases  are  traceable  to  faulty  diet.  The  system 
becomes  debilitated  because  the  food  taken  does  not 
supply  vital  power  enough  to  blood,  bone  and  muscle. 
Disease  setting  in  with  such  patients  finds  especially  easy 
prey.  Of  one  thousand  pupils  examined  surely  forty 
per  cent,  were  really  ill-nourished.  Their  pale,  drawn 
faces  and  thin  bodies  told  the  tale,  and  carrying  the  in- 
vestigation still  further  into  the  homes,  many  times  it 
was  found  that  the  child  was  a  voracious  eater,  but  always 
fondest  of  just  such  food?  as  did  not  add  to  his  mind  or 
his  muscle. 

Children  should  rise  from  bed  in  the  morning  in  suffi- 
cient time  to  eat  their  meals  slowly,  and  not  have  to 
bolt  a  hasty  breakfast.  The  habit  of  deliberate  eating 
should  be  cultivated  in  youth.  Food  taken  into  the 
mouth  in  large  portions  and  only  partially  mixed  with  the 
saliva  gives  the  stomach  three  times  the  ordinary  work. 
Soon  this  organ  rebels  and  will  be  unable  to  digest  food 
even  if  properly  taken.  Breakfast  and  supper  should  each 


School  Diet.  163 

consume  at  least  one  half-hour's  time,  and  the  dinner 
three-quarters  of  an  hour. 

Young  children  from  seven  to  fifteen  years  of  age  may 
find  it  too  long  a  time  to  wait  for  food  during  the  long 
sessions  of  the  school.  In  such  cases  the  parents  should 
send  a  lunch  to  be  eaten  at  a  definite  hour  rather  than 
sweets  or  fruit  that  will  be  nibbled  at  from  time  to  time. 
Strange  as  it  may  appear  breakfast  is  the  meal  most 
difficult  to  provide  for  the  pupil.  Often  the  anxious 
parent  brings  the  child  to  the  physician  with  the  story  that 
it  is  impossible  even  to  force  the  child  to  eat  upon  rising 
from  bed,  and  that  day  after  day  he  goes  to  school  with 
an  empty  stomach.  Long  before  noon  the  child  is  weak 
and  has  a  violent  headache.  Often  this  loss  of  morning 
appetite  is  due  to  sleeping  in  a  poorly  ventilated  room, 
or,  perhaps,  to  too  late  hours.  The  best  remedy  lies  in 
providing  plenty  of  fresh  air  in  the  sleeping  room  and 
in  sending  the  child  to  bed  in  time  to  get  sufficient  sleep 
by  early  morning,  when  an  hour  can  be  taken  for  a  walk 
or  some  exercise  before  breakfast. 

The  breakfast  meal  should  consist  of  cexeals,  eggs  of 
fish,  bread  and  butter,  fruit,  milk  or  cocoa.  If  the  tea  01 
coffee  habit  is  already  formed,  the  drink  should  be  served 
very  weak,  principally  hot  water  or  milk.  But  it  h  better 
for  children  to  avoid  tea  and  coffee  altogether,  as  there  is 


164       The  Hygiene  of  the  Schoolroom. 

no  good  derived  from  them,  and  their  injudicious  use 
often  leads  to  such  ailments  as  nervousness,  indigestion, 
and  constipation.  It  were  better  if  meat  were  not 
served  for  the  morning  meal.  The  dinner  should  be  at 
mid-day,  and  should  comprise  soups,  meat,  potatoes,  and 
other  vegetables,  with  some  pudding,  pastry,  and  fruit. 
The  best  meats  for  children  are  roast  beef,  beef  steak, 
roast  lamb,  mutton,  chicken,  and  bacon.  Pork  and  veal 
are  not  suitable.  Supper,  to  ensure  a  good  night's  sleep, 
should  be  an  easily  digested  meal.  Porridge  or  rice,  with 
milk  or  cream,  bread  and  butter  with  preserves,  some  light 
pastry  and  hot  milk,  with  but  small  portions  of  meat  and 
vegetables,  are  most  serviceable.  Many  refuse  to  give 
meat  and  vegetables  for  this  meal,  but  they  may  be  eaten 
without  harm  by  those  over  twelve  years  of  age. 

Alcohol  should  not  be  given  in  any  form  to  children. 
Setting  aside  the  moral  question,  from  a  physical  stand- 
point the  use  of  alcohol  works  only  harm  upon  the  child. 
It  retards  growth  and  induces  nervousness  and  irritability. 
These  words  are  intended  as  a  warning  to  those  among 
the  poorer  classes  who  serve  beer  to  their  children  with  the 
idea  that  it  is  good  for  them  and  will  help  their  appetite. 
The  belief  that  alcohol  in  any  form  is  an  essential  part 
of  a  healthy  diet  or  that  it  contains  any  considerable  food 
value  is  no  longer  held  by  scientists  whose  opinion  is  of 
greatest  value. 


School  Diet.  165 

The  Committee  of  Fifty,  who  gave  closest  inquiry  into 
the  alcohol  question  in  1902,  reported: 

"We  believe  that  the  occasional  or  moderate  use  is 
most  likely  to  be  harmful  to  young  persons,  and  mainly 
because  of  the  danger  of  leading  to  excess." 

"They  are  not  needed  by  young  and  healthy  persons 
and  are  dangerous  to  them  in  so  far  as  they  tend  to  cre- 
ate a  habit." 

"They  are  useless  as  preventives  of  infectious  or  con- 
tagious diseases.  On  the  contrary  they  appear  to  lessen 
the  power  of  the  organism  to  resist  the  effects  of  the 
cause  of  such  disease." 

If  the  beverage  is  not  offered  to  children  they  do 
not  desire  it.  Milk  is  cheaper  and  is  incomparably 
better  for  them.  There  can  be  no  excuse,  then, 
for  the  use  of  alcohol,  unless  prescribed  by  a  phy- 
sician. In  some  of  the  debilitating  diseases,  in  chil- 
dren suffering  from  anaemia  and  inherited  consumption, 
it  is  sometimes  prescribed  in  the  form  of  a  light  wine,  but 
its  use  should  always  be  guarded.  Milk  is  nature's  ideal 
food,  and  a  child's  home  education  is  neglected  if  he  is 
not  taught  to  drink  it  with  pleasure.  It  should  form  a 
large  part  of  the  child's  diet,  be  given  at  each  meal,  and 
even  at  night  should  a  child  wake  up  hungry.  To  per- 
sons who  are  charitably  inclined  and  ever  ready  to  help 
the  poor,  we  suggest  that  it  would  be  an  excellent  idea 


1 66        The  Hygiene  of  the  Schoolroom. 

to  establish  a  fund  for  supplying  a  daily  lunch  of  milk 
and  crackers  to  the  children  in  some  of  the  schools  whose 
ranks  are  rilled  mostly  from  the  poorer  people.  A 
glance  into  these  schools  shows  numbers  of  poorly  nour- 
ished little  ones  who  would  be  greatly  benefited  by  a 
light  lunch  in  the  middle  of  the  morning  and  the  after- 
noon session. 

Fruit  makes  healthful  food  for  the  young,  and  they 
should  be  given  a  bountiful  share  of  it  with  their  meals. 
Sweets,  meaning  thereby  candies,  would  serve  a  good 
purpose  in  supplying  a  needed  part  of  the  sugar  to  the 
system,  were  it  not  a  fact  that  so  much  is  ordinarily  taken 
as  to  destroy  the  appetite  for  the  usual  meals.  Confec- 
tionery should  never  be  a  part  of  the  school  lunch :  the 
same  applies  to  pickles,  a  favorite  relish  which  satisfies 
in  some  a  craving  for  something  bitter,  but  is  of  no  use 
as  a  food. 

For  school  diet,  then,  nutritious  foods  are  to  be  used, 
the  meals  should  be  regular,  the  articles  of  food  thor- 
oughly masticated  and  slowly  swallowed.  The  child 
should  be  taught  to  eat  those  articles  known  to  be  nu- 
tritious, even  though  he  dislikes  them  at  first.  With  a 
little  patience,  in  the  same  manner  that  he  can  be  taught 
to  overcome  any  other  repugnance,  a  child  can  be  taught 
to  eat  and  enjoy  the  foods  known  to  be  best  for  his  par- 
ticular period  of  growth. 


CHAPTER  XIV 
PHYSICAL  TRAINING  AND  EXERCISE 

It  is  important  that  the  school  in  exacting  from  the 
pupil  five  hours  of  daily  concentration  upon  study  should 
plan  periods  during  the  day  when  the  mind  can  be  rested 
and  when  pleasing,  helpful  exercises  of  the  body  be  sub- 
stituted for  mental  drill.  This  relaxation  can  be  sought 
in  any  form  of  physical  exercise  desired,  whether  in  reg- 
ular studied  calisthenics  or  in  unrestrained  play.  Phy- 
sical training  will  give  the  same  power  and  control  to  the 
muscles  that  mental  training  gives  to  the  mind. 

Calisthenics  should  be  as  compulsory  as  any  other  work 
unless  a  child  presents  a  certificate  from  a  physician  to 
the  effect  that  the  particular  child  has  something  in  his 
physical  make-up  which  forbids  this  work ;  but  because 
a  child  is  weak  and  delicate  is  no  reason  why  the  gym- 
nastic work  should  be  entirely  prohibited.  Such  cases 
demand  intelligent  treatment,  and  necessitate  a  lessening 
in  the  period  of  time  spent  rather  than  an  entire  abandon- 
ment. It  is  important,  then,  that  some  study  should  be 
given  to  the  question  of  the  exercise  most  suitable  to  age 


i68       The   Hygiene  of  the  Schoolroom. 

and  sex,  the  proper  time,  and  the  amount  of  time  to  be 
consumed. 

The  calisthenics  are  best  given  during  the  first  period 
of  school  work  and  should  not  take  over  fifteen  minutes. 
By  investigating  it  has  been  found  that  the  exercises  as 
carried  out  under  the  instruction  of  a  physical  director 
are  very  fatiguing  if  kept  up  longer  than  fifteen  minutes. 
The  principal  reason  for  this  is  that  the  work  is  too  se- 
rious and  studied  and  the  child  takes  it  as  a  task  rather 
than  a  recreation.  Some  very  careful  and  observing  ed- 
ucators have  of  late  years  recommended  for  the  lower 
grades  short  periods  of  play  at  intervals  during  the  school 
hours,  with  real  games,  which  please  and  spur  the  child 
on,  giving  the  desired  relaxation  from  mental  work. 

The  particular  exercises  given  to  the  young  are  treated 
in  books  devoted  to  this  special  subject,  but  in  general  it 
is  proper  to  insist  that  much  of  the  work  should  tend  to 
make  the  child  stand  erect,  walk  properly,  and  breathe 
well.  Respiratory  gymnastics  can  be  taught  in  the  school 
and  the  practice  taken  at  any  time;  the  training  should 
teach  that  proper  respiration  consists  not  in  quick,  sud- 
den gasps,  but  in  taking  deliberate  long  breaths  that  give 
extensive  expansion  to  the  chest.  So  important  is  the 
breathing  capacity  considered  that  all  insurance  com- 
panies in  their  medical  examinations  ask  to  know  the 


Physical   Training  and  Exercise.         169 

amount  the  chest  expands  from  a  deep  exhalation  to  a 
deep  inhalation.  Further,  it  is  a  well  known  fact  that 
people  who  continually  breathe  through  the  nose  are  less 
liable  to  infectious  diseases  and  pulmonary  complaints, 
and  that  those  who  sleep  with  the  mouth  closed  never 
awake  with  the  painful  and  disagreeable  sensation  of 
parched  throat  and  cracked  lips.  It  is  impossible,  how- 
ever, in  such  a  work  as  this  to  go  over  all  the  different 
exercises  practised  in  physical  training.  These  few 
points  about  respiratory  gymnastics  are  mentioned  only 
to  call  attention  to  the  importance  of  the  subject.  Cer- 
tain occupations,  certain  games,  tend  to  develop  certain 
sets  of  muscles;  physical  training  benefits  all  muscles. 

As  a  matter  of  economy,  in  a  number  of  communities 
attempts  have  been  made  to  have  this  line  of  work  done 
by  the  regular  teacher,  who  in  turn  was  supposed  to  have 
received  some  training  in  the  methods  of  physical  exer- 
cise. This  plan  has  always  proved  to  be  .unwise;  the 
work  is  never  carried  out  as  well  or  with  such  interest 
as  when  directed  by  a  physical  instructor. 

Athletics  in  some  form  or  other  may  be  commenced 
about  the  twelfth  year.  If  in  the  school  gymnasium,  they 
should  be  under  the  trained  eye  of  some  qualified  person, 
as  there  is  great  danger  of  young  children's  over-exert- 
ing themselves  in  trying  to  do  the  same  feats  as  their  fel- 


170       The  Hygiene  of  the  Schoolroom. 

lows.  In  the  gymnasium  two  half-hour  periods,  one  in 
each  session,  are  sufficient.  Dr.  Sargent  urges  that  no 
violent  exercise  be  taken  until  three  hours  after  a  meal. 

The  outdoor  play  is  not  so  easily  regulated  as  the  in- 
door, but  the  pupils  should  be  taught  that  no  exercise 
is  beneficial  which  is  carried  beyond  the  point  of  bodily 
fatigue.  Horseback  riding  and  bicycle  riding  are  invigo- 
rating and  healthful  exercises.  The  wheel,  however, 
should  be  used  in  moderation.  The  mooted  question  as  to 
whether  wheeling  is  a  healthful  exercise  for  girls  is  gen- 
erally settled  in  its  favor,  if  only  the  girls  use  some  dis- 
cretion and  avoid  long,  violent  rides  and  riding  at  the 
menstrual  period.  The  chief  trouble  with  boys  who  ride 
a  wheel,  is  in  getting  them  to  ride  in  an  upright  position, 
their  desire  to  be  racers  inducing  them  to  assume  a 
stooped  position  which  is  anything  but  beneficial.  The 
principal  exercises  suitable  for  girls  are  golf,  lawn  tennis, 
swimming,  fencing,  and  basket-ball.  All  are  sufficiently 
exhilarating  to  be  enjoyed  and  do  not  require  the  great 
endurance  that  some  of  the  more  rugged  sports  do. 
Baseball,  football,  rowing,  boxing,  wrestling,  bowling, 
swimming,  and  running  are  the  exercises  that  best  please 
the  boys.  All  should  be  learned  and  practised.  Some 
have  a  good  influence  on  one  set  of  muscles,  while  others 
help  the  lungs,  heart,  and  stomach. 


Physical  Training  and  Exercise.         171 
Every  teacher  should  interest  himself  or  herself  in  out- 

4 

door  sports  and  remember  that  the  ideal  pupil  is  the  one 
that  leaves  the  school  with  a  strong  mind  to  battle  with 
the  world  and  a  strong  body  to  carry  that  mind  about  in. 
There  are  too  many  children  who  are  encouraged  to 
spend  their  spare  time  at  school  and  at  home  always  with 
books  that  they  may  excel  in  their  studies,  and  yet  who 
are  easily  distanced  later  in  the  real  school  of  life  by  their 
less  intellectual  but  more  sturdy  fellows. 


CHAPTER  XV 
CORPORAL  PUNISHMENT 

It  is  but  a  few  years  since  the  practice  of  corporal  pun- 
ishment was  very  general.  Severe  punishments  and  flog- 
gings were  often  resorted  to,  even  to  such  an  extent  as  to 
physically  disable  the  pupil  for  a  few  days  at  the  time. 
Schools  in  certain  districts  engaged  their  teachers  upon 
muscular  qualifications  rather  than  mental.  Thrashing 
was  thought  to  be  an  essential  to  education,  and  if  a  pupil 
did  not  or  would  not  learn  the  lessons,  he  had  them 
"knocked  into  him."  It  is  pleasing  to  note,  however, 
that  with  the  great  improvement  in  all  educational  mat- 
ters this  practice  has  almost  entirely  disappeared.  To- 
day better  discipline  is  maintained  in  just  such  schools  by 
young  "school-ma'ams"  who  never  wield  the  birch  but 
have  been  carefully  trained  in  properly  handling  school 
children.  To-day  the  best  teachers  are  those  who  find 
least  need  to  resort  to  corporal  punishment. 

But  there  still  goes  on  a  discussion  as  to  the  necessity 
at  any  time  of  corporal  punishment,  by  which  we  mean 
some  pain  or  suffering  inflicted  upon  the  body  of  the  pu- 


Corporal  Punishment.  173 

pil  for  some  offence  against  the  school  law.  Many  who 
have  gladly  seen  its  use  lessened  to  a  minimum  contend 
very  strongly  that  there  still  is  a  use  for  guarded  corporal 
punishment  in  the  schoolroom  and  that  there  are  cases 
which  cannot  be  successfully  treated  by  other  means. 
And  there  are  undoubtedly  some  few,  the  bullies  usually, 
who  sneer  at  moral  suasion  and  any  corrections  other 
than  corporal  punishment. 

On  the  other  hand  there  are  those  who  insist  upon  the 
entire  abolition  of  corporal  punishment  in  schools,  hold- 
ing that  it  is  never  of  any  use  as  a  corrective  measure; 
that  wherever  allowed,  it  is  abused ;  and  that  it  is  an  end- 
less source  of  trouble  between  teacher  and  parent.  It  is 
probable  that  the  truth  lies  half-way  between, — that  in 
the  great  majority  of  cases  other  means  should  be  re- 
sorted to,  but  that  doubtless  there  are  cases  where,  with- 
out the  use  of  corporal  punishment,  no  impression  what- 
soever can  be  made. 

Rollin,  the  French  historian  so  well  known  from  his 
Ancient  History,  early  in  the  i8th  century  wrote  a  "Treat- 
ise on  Studies,"  in  which  he  has  well-defined  views  on  the 
subject  under  consideration.  The  following  are  a  few 
extracts : 

"i.  The  first  duty  of  the  teacher  is  to  study  well  the 
genius  and  character  of  children.  To  wish  to  place  them 


174       The  Hygiene  of  the  Schoolroom. 

on  the  same  level,  and  to  subject  them  to  a  single  rule, 
is  to  force  nature. 

"2.  In  education  the  highest  skill  consists  in  knowing 
how  to  unite,  by  a  wise  temperament,  a  force  that  re- 
strains children  without  repelling  them,  and  a  gentleness 
that  wins  without  enervating  them. 

"3.  The  short  and  common  method  of  correcting 
children  is  with  the  rod ;  but  this  remedy  sometimes  be- 
comes a  more  dangerous  evil  than  those  which  one  seeks 
to  cure,  if  it  is  employed  without  reason  and  moderation. 

"4.  The  only  vice,  it  seems  to  me,  that  deserves  se- 
vere treatment  is  obstinacy  in  evil,  but  an  obstinacy  vol- 
untary, determined,  and  well  defined. 

"5.  The  teacher  ought  never  to  punish  in  anger, 
especially  if  the  fault  which  he  punishes  concerns  him 
personally,  such  as  a  want  of  respect  or  some  offensive 
speech. 

"6.  Cuffs,  blows,  and  other  like  treatment,  are  abso- 
lutely forbidden  to  teachers.  They  ought  to  punish  only 
to  correct,  and  passion  does  not  correct. 

"7.  It  is  a  quite  common  fault  to  make  use  of  repri- 
mands for  the  slightest  faults  which  are  almost  inevitable 
to  children.  This  breaks  the  force  of  reprimands  and 
renders  them  fruitless. 


Corporal   Punishment.  175 

"8.  We  should  avoid  exciting  the  spite  of  children  by 
the  harshness  of  our  language,  their  anger  by  exaggera- 
tion, their  pride  by  marks  of  contempt. 

"9.  It  is  necessary  always  to  show  children  a  substan- 
tial and  agreeable  end  which  may  hold  them  to  work,  and 
never  pretend  to  force  them  by  a  direct  and  absolute  au- 
thority. 

"10.  We  should  run  the  risk  of  discouraging  child- 
ren if  we  never  praised  them  when  they  do  well.  Al- 
though praises  are  to  be  feared  because  of  vanity,  it  is 
necessary  to  make  use  of  them  to  encourage  children, 
without  cultivating  that  vice. 

"11.  Rewards  are  not  to  be  neglected  for  children, 
and  although  they  are  not,  any  more  than  praise,  the 
principal  motive  to  make  them  act,  yet  both  may  become 
useful  to  virtue,  and  a  strong  incentive  to  its  practice/' 

Horace  Mann,  in  his  "Lectures  on  Education,"  in  re- 
ference to  this  subject  says :  "Yet  great  as  the  evil  is, 
I  admit  that  it  is  less  than  the  evil  of  insubordination  or 
disobedience.  It  is  better,  therefore,  to  tolerate  punish- 
ment, in  cases  where  the  teacher  has  no  other  resource, 
than  to  suffer  insubordination  or  disobedience  in  our 
schools.  Yet  how  infinitely  better  to  secure  order  and 
proficiency  by  the  power  of  conscience  and  the  love  of 
knowledge — to  supersede  the  necessity  of  violence  by 


176       The  Hygiene  of  the  Schoolroom. 

moral  means.  This  is  already  done  in  a  considerable 
number  of  schools ;  I  trust  it  is  done,  with  regard  to  some 
scholars,  in  every  school ;  that  is,  I  trust  there  are  at  least 
some  scholars,  in  every  school  in  the  Commonwealth,  who 
never  know  the  degradation  of  the  lash.  I  trust  there  is 
no  teacher  with  such  a  vacuum  of  good  qualities  and 
such  a  plenum  of  bad  ones,  as  to  create  the  necessity  tor 
indiscriminate  and  universal  flogging.  What,  then,  ought 
teachers  to  do?  I  answer,  they  should  aim  to  reach 
those  higher  and  higher  points  of  qualification,  which 
shall  enable  them  to  dispense  more  and  more  with 
the  necessity  of  punishment.  If  there  is  any  teacher 
so  low  in  the  scale  of  fitness  or  competency  as  to  feel 
obliged  to  punish  every  day,  he  should  strive  to  prolong 
the  interval  to  once  a  week.  If  any  teacher  punishes  but 
once  a  quarter,  he  should  strive  to  punish  but  once  a 
year." 

Editorially  speaking  on  this  subject,  the  New  York 
Medical  Record  says,  "The  question  of  corporal  punish- 
ment in  schools  has  been  much  discussed  lately  in  Ger- 
many and  Switzerland,  and  the  Canton  Berne  has  come 
to  a  decision  in  the  matter.  The  Ethical  World  considers 
the  new  law  a  compromise  between  the  flagellants  and  the 
anti-flagellants.  It  prescribes  the  use  of  the  cane  for 
grave  faults  such  as  indicate  moral  perversion;  repeated 


Corporal   Punishment.  177 

lying  is  given  as  an  instance,  and  it  is  expressly  forbid- 
den to  punish  for  want  of  application.  Girls  are  not  to 
be  punished  physically  at  all." 

Certain  forms  of  punishment  are  never  to  be  tolerated, 
such  as  pulling  or  boxing  of  the  ears.  Serious  damage 
has  time  and  time  again  been  done  by  teachers  who,  in 
their  haste,  have  inflicted  punishment  in  this  manner. 
Slaps  or  blows  upon  the  head  likewise  cause  at  times 
grave  discomforts  which  persist  for  some  time,  such  as 
dizziness  and  headache.  It  is  well  to  remember,  as  Dr. 
Bristowe  says,  that  there  are  some  parts  of  the  body  that 
seem  to  be  made  for  chastisement ;  and  he  speaks  of  the 
"posterior  aspect  of  the  human  form  divine."  j  There  is 
nothing  so  demoralizing  to  discipline  as  for  a  teacher  to 
strike  such  a  blow  in  anger  and  then  spend  the  following 
hour  in  coddling  back  the  same  child  to  good  nature. 
If  corporal  punishment  is  to  be  inflicted,  it  should  not  be 
done  at  the  time  of  the  offense,  but  later,  when  all  traces 
of  anger  that  might  have  existed  shall  have  passed  away. 

Keeping  in  at  recess  and  after  school  is  not  a  right 
means  of  punishment,  as  all  agree  that  the  school  hours 
are  sufficiently  long  and  fatiguing.  Such  tasks  as  stand- 
ing for  long  periods  should  not  be  imposed  on  growing 
children,  as  long  continued  standing  conduces  to  stooped 
shoulders  and  curvatures  of  the  spine.  Committing  to 


178        The   Hygiene  of  the  Schoolroom. 

memory  or  writing  long  extracts  accomplish  but  little  in 
a  corrective  way.  The  most  satisfactory  means  of  cor- 
rection with  many  pupils  will  not  be  in  imposing  difficult 
tasks  at  the  expense  of  bodily  energy,  but  the  deprivation 
of  certain  privileges  and  pleasures  that  are  accorded  their 
better-behaved  fellows. 

Before  punishing  for  want  of  application  the  teacher 
must  satisfy  herself  of  two  things :  first,  that  the  task  be 
not  greater  than  the  ability;  and  secondly,  that  there  is 
no  bodily  defect  which  unfits  the  pupil  for  school  work, 
such  as  defects  of  eyes  or  ears,  or  any  abnormalities, 
such  as  adenoid  growths  in  the  throat. 


CHAPTER  XVI 
SICKNESS  AND  ACCIDENT  IN  THE  SCHOOLROOM 

In  considering  ideal  conditions  in  the  schoolroom  that 
tend  to  the  prevention  of  sickness  and  accident,  it  is  but 
a  step  away  to  dwell  for  a  moment  on  what  is  first  to  be 
thought  of  when  such  complications  arise  in  school.  It 
is  a  wise  thing  for  a  teacher  to  know  what  to  do  and  what 
not  to  do, — to  know  her  own  real  limitations. 

Ordinarily  if  "a  little  knowledge  is  a  dangerous  thing," 
then  a  little  knowledge  of  medicine  and  surgery  is  doubly 
dangerous;  but  in  the  government  of  hundreds  of  chil- 
dren gathered  under  one  roof  and  engaged  at  times  in 
rough  games,  accidents  are  sure  to  occur  and  the  teacher 
is  always  the  first  one  to  look  to  in  such  emergencies. 
The  same  applies  with  equal  force  to  the  minor  ailments 
of  children  during  the  school  hours. 

With  sickness  the  teacher  may  use  such  natural  means 
as  her  knowledge  directs,  like  applications  of  hot  or  cold 
water,  vigorous  rubbing,  recumbent  posture,  or  removal 
to  a  quiet  room,  but  she  should  never  use  medicines  with 
any  of  the  pupils.  The  giving  of  medicine  is  entirely  be- 


i8o       The  Hygiene  of  the  Schoolroom. 

yond  her  province,  and  though  always  done  with  good  in- 
tent may  sometimes  lead  to  unpleasant  complications. 
Reference  is  made  principally  to  the  use  of  headache  pills, 
powders,  or  capsules  which  are  in  such  common  use,  yet 
all  of  which  contain  dangerous  drugs. 

Headache  may  be  treated  by  removal  from  the  main 
room,  which  is  often  apt  to  be  overcharged  with  impure 
air,  and  by  applications  to  the  forehead  of  cold  water, 
and  of  smelling-salts  to  the  nostrils,  with  dismissal  if  the 
pain  persists  over  a  half-hour.  Injury  to  the  eyes  may  be 
the  cause  of  constantly  recurring  headache ;  often  chang- 
ing the  seat  to  give  more  favorable  light  will  be  of  benefit. 

With  toothache  and  earache  it  is  not  wise  to  use  any- 
thing but  applications  of  hot  cloths  externally.  If  this 
means  be  not  successful,  other  means  of  relief  should  be 
sought  outside  the  schoolroom. 

Fainting  is  a  common  occurrence  in  schools,  but  usually 
is  of  only  momentary  importance.  A  child  who  has 
fainted  should  be  immediately  taken  from  the  presence  of 
the  other  pupils  and  laid  down  with  the  feet  several  inches 
higher  than  the  head.  The  clothing  should  be  loosened 
and  the  face  and  hands  bathed  in  cold  water.  Within 
five  minutes  there  should  be  some  signs  of  returning  con- 
sciousness, shown  by  muscular  movements  and  return 
of  blood  to  the  face. 


Sickness  and  Accident  in  the  Schoolroom.  181 

Fits  or  convulsions  are  less  remediable,  occupying  a 
regular  interval  and  being  little  influenced  by  outside 
reatment.  They  are  usually  a  form  of  epilepsy,  most 
often  what  is  called  "petit  mal"  and  when  encountered 
:.t  school  should  be  treated  like  fainting  spells.  What- 
jver  measures  are  resorted  to  'will  do  little  beyond  serv- 
ing the  useful  purpose  of  keeping  those  about  employed 
in  doing  something.  With  many  cases  of  epilepsy  it  is 
not  advisable  to  send  the  patient  to  school  at  all,  as  attacks 
then  occur  with  greater  frequency;  but  numerous  cases 
just  on  the  border  line  where  the  spells  are  infrequent 
and  mild  are  found,  that  do  well  at  school. 

Attacks  of  hysteria,  such  as  immoderate  laughing  or 
crying  without  cause,  are  difficult  to  handle.  They  require 
a  firm  will  to  combat  their  display  and  never  should  be 
given  any  coddling  or  petting. 

When  one  is  sunstruck  or  overcome  with  the  heat  it  is 
advisable  to  secure  as  speedily  as  possible  a  physician's 
services.  In  the  meantime,  the  patient  should  be  removed 
to  a  shady  spot,  the  clothing  loosened,  and  applications  of 
cold  water  and  cold  cloths  made. 

In  cases  of  frost-bite,  which  usually  affects  the  ears, 
hands,  or  feet,  the  affected  portion  should  be  vigorously 
rubbed  with  snow  or  ice  water  and  heat  should  be  applied 
only  very  gradually. 


1 82       The  Hygiene  of  the  Schoolroom. 

For  accidents  it  would  be  wise  for  a  teacher  to  keep  on 
hand  such  articles  as  a  few  bandages,  some  absorbent 
gauze  and  cotton,  vaseline,  and  a  solution  of  carbolic  acid, 
one  part  to  100  of  water.  Many  minor  accidents  could 
be  looked  after  easily  with  such  dressing  at  hand.  A 
teacher  should  be  everything  to  the  child  at  school  that 
the  mother  is  at  home. 

Bruises  and  many  cuts,  if  they  seem  to  be  of  no  depth 
or  importance,  can  be  bandaged  at  the  time  of  accident. 
The  immediate  bandaging  of  bruises  about  the  head  will 
give  relief  and  prevent  future  swelling. 

A  dog  bite  should  at  first  be  thoroughly  cleansed,  and 
then  cauterized  by  a  surgeon. 

Burns,  unless  of  a  very  minor  degree,  should  be  treated 
by  a  surgeon  after  a  preliminary  application  of  vaseline 
has  been  made. 

Nosebleed  is  best  overcome  by  placing  the  patient  in  a 
sitting  posture,  and  applying  pressure  to  both  nostrils 
without  any  effort  at  blowing.  If  persistent,  there  are  a 
number  of  other  means  to  be  used.  Raise  the  arms 
above  the  head,  apply  ice  to  the  nostrils  and  to  the  back 
of  the  neck,  immerse  the  lower  limbs  in  hot  water  to  the 
knees  or  bandage  them.  Hot  water  or  ice  may  be  intro- 
duced into  the  nostrils.  Should  the  use  of  these  expedi- 
ents not  suffice  more  skillful  treatment  may  be  required. 


Sickness  and  Accident  in  the  Schoolroom.  183 

Hemorrhage  from  any  bleeding  vessel  is  best  controlled 
by  applying  a  compress  of  a  folded  towel,  preferably 
soaked  in  hot  water,  to  the  affected  part.  If  one  of  the 
larger  vessels  of  the  limbs  is  severed,  more  heroic  treat- 
ment is  necessary.  Then  the  first  thing  to  do  is  to  get  at 
the  source.  If  necessary  cut  the  clothing  away  and  apply 
compression  by  means  of  a  tourniquet,  which  may  be 
quickly  improvised  by  tying  a  handkerchief  or  bandage 
about  the  leg  above  the  injury,  inserting  a  stick  between 
the  handkerchief  and  limb  and  twisting  the  stick  about 
until  the  bleeding  stops.  Sometimes  where  the  hemor- 
rhage is  from  a  vein,  the  bleeding  continues  until  a 
tourniquet  is  applied  to  the  distal  side  of  the  wound. 

Where  a  limb  is  injured  and  a  fracture,  dislocation,  or 
sprain  is  suspected,  put  the  limb  to  rest  by  attaching  it  to 
some  form  of  a  splint  and  send  for  surgical  aid.  Do  not 
allow  the  limb  to  be  pulled  or  manipulated  in  any  way, 
as  it  will  do  no  good  and  cause  great  pain. 

When  foreign  bodies,  such  as  bits  of  dirt  and  cinders, 
get  into  the  eye,  forbid  the  child  to  rub  it.  Attempt  to 
cleanse  the  eye  with  cold  water  holding  the  two  lids 
separated  with  thumb  and  forefinger ;  or  the  sub- 
stance may  be  removed  by  drawing  the  upper  lid  down 
over  the  lower  lid.  If  one  is  skillful  enough,  the  upper 
lid  may  be  rolled  over  a  pencil  and  search  easily  made  for 


184       The  Hygiene  of  the  Schoolroom. 

the  offending  substance,  which  may  then  be  removed  with 
a  clean  silk  handkerchief. 

Foreign  bodies  in  the  ear  are  only  to  be  removed  by 
syringing  with  warm  water.  Sometimes  flies  and  other 
insects  crawl  into  the  ear,  causing  great  buzzing  and  dis- 
comfort. In  such  cases,  if  a  lighted  candle  or  lamp  is 
held  at  the  ear  the  insect  will  usually  see  the  light  and 
come  out.  When  this  fails,  a  few  drops  of  warm  olive  oil 
or  glycerine  dropped  into  the  ear  will  suffice. 

Where  a  school  is  in  the  vicinity  of  a  .river,  as  is  often 
the  case,  drowning  accidents  are  by  no  means  uncommon. 
Whenever  a  person  is  removed  from  the  water  in  an  un- 
conscious and  asphyxiated  state,  quick  action  is  needed. 
It  is  impossible  to  have  a  number  of  rules  at  the  finger 
ends  to  use,  but  a  careful  perusal  of  the  following  method, 
known  as  Sylvester's  method  of  treatment  of  asphyxia 
from  drowning,  gives  general  ideas  which  should  not  be 
forgotten : 

Remove  from  the  mouth  and  nostrils  all  obstructions 
to  the  free  passage  of  air  to  the  lungs ;  free  the  body  from 
any  clothing  that  binds  the  neck,  chest  or  waist ;  turn  the 
body  over  upon  the  face  for  a  moment,  thrusting  a  finger 
into  the  mouth  and  sweeping  it  round,  to  bring  away 
anything  that  may  have  accumulated  there.  Then 
lay  the  body  flat  on  the  back,  with  something  a  few 
inches  high  under  the  shoulders,  so  as  to  cause  the  neck 


Sickness  and  Accident  in  the  Schoolroom.  185 

to  be  stretched  out  and  the  chin  to  be  carried  from  the 
chest.  Draw  the  tongue  well  forward  out  of  the  mouth 
and  let  it  be  held  by  an  assistant.  (If  there  be  no  one 
present,  a  pencil  or  small  stick  may  be  thrust  across  the 
mouth  on  top  of  the  tongue  and  behind  the  last  teeth,  to 
keep  the  mouth  open  and  the  tongue  out  of  the  throat.) 
Place  yourself  on  your  knees  behind  the  head,  seize  both 
arms  near  the  elbows  and  sweep  them  round  horizontally, 
away  from  the  body  and  over  the  head,  till  they  meet 
above  it;  give  a  good,  strong  pull,  and  repeat  every  few 
seconds.  After  this,  return  the  arms  to  their  former  posi- 
tion alongside  the  chest,  and  make  strong  pressure  against 
the  lower  ribs,  so  as  to  drive  the  air  out  of  the  chest  and 
effect  an  act  of  expiration.  This  need  occupy  but  a  sec- 
ond of  time. 

This  plan  regularly  carried  out,  will  make  about  sixteen 
complete  acts  of  respiration  in  a  minute.  It  should  be 
kept  up  for  a  long  time,  and  not  abandoned  until  the 
heart  has  ceased  to  beat.  It  should  be  remembered  that 
cessation  of  the  pulse  at  the  wrists  amounts  to  nothing 
as  a  sign  of  death ;  and  life  is  present  when  only  a  most 
acute  ear  can  detect  the  sound  of  the  heart.  In  a  moder- 
ately thin  person,  deep  pressure  with  the  finger-ends  just 
below  the  lower  end  of  the  breastbone  may  sometimes  re- 
veal pulsation  in  the  aorta  when  it  cannot  be  found  any- 
where else. 


CHAPTER  XVII 
THE  TEACHER'S  HEALTH 

As  the  teacher  lives  in  the  same  atmosphere  as  the  child 
during  school  hours,  what  is  beneficial  to  one  is  equally 
so  to  the  other ;  but  in  many  respects  conditions  are  vastly 
different.  The  bad  air,  the  poor  light,  and  the  oppressive 
heat  are  felt  by  both,  but  with  the  teacher  there  is  the  ad- 
ditional sense  of  responsibility  and  a  continuous  and 
wearing  nervous  strain. 

The  advent  of  specialization  in  school  work  divides  the 
responsibility  somewhat,  but  nevertheless  the  teacher 
must  needs  be  a  paragon  of  all  virtues.  She  must  be 
strong  and  of  good  disposition.  If  not  strong  and  often 
ill,  the  school  work  suffers  from  the  numerous  changes  in 
teaching  and  governing.  If  the  teacher  be  nervous  or  ir- 
ritable, she  will  do  harm  to  the  dispositions  of  the  chil- 
dren by  keeping  them  in  a  continual  state  of  anxiety.  A 
physical  examination  should  be  demanded  of  every  appli- 
cant for  a  teacher's  position.  The  following  are  impor- 
tant points: 

I.  There  should  be  no  physical  defect,  such  as  curva- 
ture of  the  spine.  One  so  affected,  howsoever  qualified 


The  Teacher's  Health.  187 

mentally,  is  not  a  desirable  candidate.  Her  physical 
strength  would  naturally  be  below  par  and  the  effect  of 
such  a  deformity  upon  young  children  would  not  be  good. 

II.  The  heart  and  lungs  should  be  normal  and  free 
from  organic  disease.     This  is  essential  for  good  bodily 
strength  which  will  be  needed  to  keep  the  school  work 
up  to  the  standard.     A  sickly  teacher  is  a  listless  teacher. 

III.  The  eyes  and  ears  should  be  examined  for  de- 
fectiveness.     Faults  in  the  eyes  can  in  most  cases  be  easily 
corrected  by  proper  glasses,  but  a  fault  in  the  ears  is  more 
serious.     If  existing  to  any  great  degree  it  should  be  a 
permanent  bar  to  an  applicant's  appointment. 

IV.  A  good  speaking  voice  is  needed  in  order  that  the 
instruction  may  easily  be  heard  in  all  parts  of  the  school- 
room.    A  high  pitched,  harsh  voice  grates  unpleasantly 
on  the  children's  nerves. 

V.  There  should  be  a  general  summing  up  of  the  en- 
tire system,  just  as  the  medical  examiner  of  a  life  insur- 
ance company  decides  whether  an  applicant  for  a  policy 
is  a  good  risk.     If  there  be  lowered  vitality  in  any  re- 
spect, if  the  applicant  would  prove  to  be  a  poor  risk  for 
an  insurance  company  to  assume,  she  will  prove  to  be  a 
poorer  risk  for  the  school  board. 

VI.  A  careful  study  should  be  made  of  the  applicant's 
disposition,  in  order  to  weed  out  all  victims  of  the  great 
American   disease  of  "nerves,"  whether  sufferers   from 


1 88       The  Hygiene  of  the  Schoolroom. 

simple  nervousness  and  irritability  or  from  the  more  pro- 
nounced form  of  nervous  exhaustion. 

A  teacher  who  finds  herself  unable  to  restrain  her  ner- 
vousness and  irritability  should  be  conscientious  enough 
to  seek  another  occupation,  as  this  is  proof  positive  that 
she  has  not  the  requisite  qualifications  to  preside  over 
children. 

The  most   common  affections  among  school-teachers 

are  nervous  diseases,  dyspepsia,  anaemia,  and  tuberculosis. 

The  medical  inspector  should  be  empowered  to  examine 

all  teachers  yearly  and  to  exclude  from  school  work  any 

suffering  from  tuberculosis.    The  teacher,  more  fortunate 

than  many  people  in  other  walks  of  life,  has  a  considerable 

space  of  time  at  her  disposal.     A  portion  of  this  time, — 

at  least  an  hour — -should  be  daily  spent  in  exercise.     This 

is  the  great  remedy  for  the  common  condition  of  "nerve 

tire."     No  medicines  will  so  effectually  wipe  away  this 

feeling  of  exhaustion  as  a  romp  through  fields  and  woods, 

a  spin  upon  the  wheel,  a  game  of  golf  in  the  summer,  or 

an  hour's  indoor  gymnasium  work  in  the  winter.     Let  the 

school  teacher  remember  that  as  the  nervous  force  is  in 

such  constant  demand  it  should  be  conserved  in  every 

possible  manner.     When  symptoms  of  fatigue  and  nerve 

strain  are  felt,  avoid  the  use  of  such  medicines  as  nerve 

tonics,  which  will  in  the  end  do  only  harm,  and  seek  relief 

in  exercise  or  periods  of  rest. 


The  Teacher's  Health.  189 

It  is  wrong,  however,  for  the  teacher  to  become  imbued 
with  the  idea  that  hers  is  the  most  exhausting  and  life- 
destroying  occupation  known.  Some  writers  of  late  have 
dilated  upon  this  idea  and  one  superintendent  of  schools 
goes  so  far  as  to  say  that  five  years'  actual  service  will  be 
sufficient,  in  the  majority  of  cases,  to  ruin  a  teacher's 
health.  But  experience  and  statistics  will  not  bear  this 
statement  out,  as  school  teachers  enjoy  an  especially  fa- 
vorable place  in  the  tables  of  expectancy  of  life.  Though 
consumption  claims  the  largest  number  of  victims,  even 
this  disease  is  proportionally  less  frequent  among  teachers 
than  among  persons  of  any  other  occupation.  Diseases 
of  the  nervous  system  rank  second,  and  heart  disease 
third,  as  causes  of  death.  But  even  so,  the  Eleventh  Cen- 
sus of  the  United  States  gives  the  death  rates  of  male 
teachers  as  9.28  per  thousand,  and  of  female  teachers  4.32 
per  thousand,  and  further  says  that  the  death  rate  of 
teachers  is  much  less  than  the  average  rate  for  all  other 
selected  occupations.  On  the  whole,  then,  "we  must  take 
the  rough  and  the  thorny  as  well  as  smooth  and  pleasant, 
and  a  portion  at  least  of  our  daily  duty  must  be  hard  and 
disagreeable,  for  the  mind  cannot  be  strong-  and  healthy 
in  perpetual  sunshine  only,  and  the  most  dangerous  of 
all  states  is  that  of  constantly  recurring  pleasure,  ease, 
and  prosperity." 


CHAPTER  XVIII 
DEFECTIVE  CHILDREN 

IN  all  civilized  communities,  there  will  be  found  a  cer- 
tain proportion  of  children,  about  j3ne  to  every  five  hun- 
dred, who  from  one  cause  or  another  are  not  the  mental 
equals  of  the  average  child. 

Seguin  defines  this  class  as  children  in  whom  is  pres- 
ent functional  torpidity  or  backwardness  of  the  nervous 
apparatus,  but  who  are  not  sufficiently  abnormal  to  be 
classed  as  idiots  or  imbeciles.  They  are  commonly 
spoken  of  as  backward  children.  Among  this  class  there 
are  many  subdivisions,  leading  from  the  one  of  simple  re- 
tarded mental  development  to  well-defined  cases  of  idiocy 
and  imbecility. 

A.  There  is  a  large  class  who  have  no  organic  or 
functional  disease,  but  who  are  extremely  slow  in  the 
process  of  mental  unfolding.  In  school,  these  are  the  ex- 
tremely dull  pupils  who  find  all  forms  of  mental  exertion 
difficult.  They  are  particularly  troubled  with  arithmetic, 
less  so  with  reading  and  writing.  Such  children  do  not 
learn  to  creep,  walk  or  talk  until  a  much  later  period  than 


Defective  Children.  191 

the  normal  child.  At  the  age  of  ten  years  they  usually 
have  the  mentality  of  a  child  four  or  five  years  of  age. 
They  are  apt  to  be  the  butt  of  ridicule  of  their  playmates 
and  are  often  teased  and  hazed  beyond  endurance. 

Much  can  be  done  in  developing  these  children  under 
proper  environment.  They  should  be  in  a  school  for- 
backward  children,  under  the  care  of  a  teacher  who  has 
proper  interest  and  sympathy  with  them. 

Their  progress  is  necessarily  slow  and  the  tasks  as- 
signed to  compensate  with  their  enfeebled  brain  power 
should  not  be  more  than  one-fourth  the  regular  tasks.  It 
is  impossible  for  one  teacher  to  care  for  and  do  justice  to 
more  than  ten  such  pupils. 

The  superintendent  of  the  schools  of  Batavia,  N.  Y., 
made  use  of  an  interesting  experiment  for  the  benefit 
of  backward  children,  which  elicited  favorable  comment 
from  the  educational  and  medical  professions.  Finding 
that  a  certain  proportion  of  the  pupils  experienced  a 
great  mental  and  physical  strain  in  trying  to  keep  up 
to  the  ordinary  school  standard,  he  put  into  practice  a 
very  rational  plan  to  stop,  as  he  said,  "this  killing  of 
children."  He  advised  in  every  room  an  extra  teacher 
whose  sole  efforts  were  to  be  applied  in  helping  those 
who  were  constantly  behind  their  regular  classes.  The 
experiment  has  been  tried  elsewhere  with  the  same  strik- 
ing success  that  makes  one  wonder  that  so  excellent  an 
expedient  had  not  long  since  been  in  use. 


192       The  Hygiene  of  the  Schoolroom. 

The  most  interesting  features  of  the  "Batavian  experi- 
ment" are  that  the  scholarship  was  improved  and  the 
health  of  the  child  was  noticeably  benefited.  The  mental 
load  was  made  lighter  for  the  child  and  naturally  the 
physical  strain  was  lessened. 

It  was  found  that  under  the  new  regime  a  far  greater 
number  of  pupils  each  year  continued  their  school  work, 
and  in  the  high  school  six  times  the  former  number  of 
pupils  remained  to  graduate.  The  experiment  deserves 
especial  study  and  imitation.  The  matter  of  expense 
would  readily  be  borne  in  consideration  of  the  helpful- 
ness and  healthfulness  that  would  soon  be  apparent. 

B.  There  are  those  children  who  are  defective  by  rea- 
son of  the  loss  of  one  or  more  of  the  special  senses, — as 
the  blind,  the  deaf  and  the  dumb.    Fortunately  there  are 
provided  rn  all  states  excellent  institutions  for  the  care 
and  education  of  these  afflicted  ones.     With  this  class  of 
defectives  far  better  work  will  be  had  when  the  entire 
control  of  the  child  is  given  up  to  the  institution. 

C.  The  morally  defective  are  that  class  in  whkh  the 
"moral  sense  which  causes  a  human  being  to  weigh,  con- 
sider and   approve   or   disapprove   his   own   conduct,  is 
blunted  or  absent." 

They  are  especially  difficult  to  control,  not  susceptible 
to  reproof  and  training,  and  punishment  in  their  case  is 
of  no  avail. 


Defective  Children.  193 

Maudsley  speaks  of  this  class  as  persons  "who  are  born 
with  an  entire  absence  of  the  moral  sense,  destitute  even 
of  the  possibility  of  moral  feeling.  They  are  as  truly  in- 
sensible to  the  moral  relations  of  life,  as  deficient  in  this 
regard  as  a  person  color  blind  is  to  certain  colors,  or  as 
one  who  is  without  ear  to  music  is  to  the  finest  harmonies 
of  sound."  They  are  ordinarily  beings  of  good  physical 
health,  but  for  their  own  good  as  well  as  public  good  they 
should  have  the  constant  and  restraining  influence  of  an 
institution. 

D.  There  is  a  type  with  all  the  special  senses,  but 
without  the  power  of  attention.     Such  children  are  sin- 
gularly  difficult    to   instruct,    for   the   most   painstaking 
labors  and  frequently  repeated  suggestion  will  be  with- 
out avail. 

E.  Another  class  is  distinguished  by  being  deficient 
in  will  power.      Nervousness,  caused  by  overstudy  and 
overwork,  sometimes  causes  this  paralysis  of  will  power, 
and  it  is  often  noted  at  or  about  the  period  of  puberty. 
This  loss  of  will  power  is  a  very  constant  symptom  asso- 
ciated with  aggravated  forms  of  hysteria.     Such  cases 
are  capable  of  great  improvement,  but  only  after  long 
periods  of  rest  under  a  helpful  regime  of  exercise  and 
fresh  air.     They  are  poor  subjects  for  school  work  and 
very  little  mental  work  should  be  expected  of  them. 

F.  There  is  another  class,  comprising  children  who 
possess  normal  senses  but  lack  the  power  of  memory, 


194       The  Hygiene  of  the  Schoolroom. 

failing  to  retain  even  for  a  short  time  recent  instruction. 
This  condition  sometimes  follows  debilitating  sicknesses, 
injuries  and  epilepsy. 

It  is  a  condition  most  often  met  with  in  later  child  life, 
and  has  little  tendency  towards  improvement. 

G.  There  are  then  the  many  cases  of  imbecility  and 
idiocy  wherein  exist  defective  or  arrested  cerebral  devel- 
opment. 

There  is  no  known  means  of  reorganizing  a  defective 
brain ;  but  much  good  can  be  done  by  tactful  teachers  in 
a  properly  equipped  institution.  With  many  cases  of  all 
classes  enumerated  some  improvement  can  be  made. 
Many  if  taken  in  time  can  be  made  to  be  helpful  members 
of  society  rather  than  dependents.  The  ordinary  public 
school  has  no  opportunity  for  training  these  cases.  The 
work  must  be  carried  on  in  special  schools  or  institutions 
under  civic  aid  and  civic  law.  Every  city  should  have 
its  school  for  backward  children,  every  state  should  have 
its  homes  for  the  more  helpless  and  dependent.  Many 
of  the  children  are  so  slightly  below  the  standard  that 
they  may  receive  satisfactory  training  at  home  supple- 
mented by  daily  attendance  at  a  special  school.  The 
training  is  principally  along  the  physical  side;  indeed, 
this  is  the  most  promising  avenue  open  to  improvement. 

Dr.  Martin  W.  Barr,  chief  of  Pennsylvania  Training 
School  for  Feeble  Minded  Children,  says,  "The  motto  of 
the  schools — 'We  learn  by  doing ;  the  working  hand  mak- 


Defective  Children.  195 

ing  strong  the  working  brain,' — shows  manual  training 
to  be  the  basis  of  the  scheme  of  development,  varied  for 
each  grade  to  suit  the  intelligence." 

In  the  Elmira  Reformatory  excellent  results  are 
reached  after  this  same  plan  of  developing  the  brain  from 
the  physical  side.  The  defectives  are  divided  into  three 
classes:  i,  those  who  are  intellectually  weak  but  have 
powers  of  self-control ;  2,  those  who  are  bright  but  lack- 
ing in  self-control,  and  3,  those  who  are  weak  and  also 
lacking  in  self-control.  Physical  training  and  manual 
training  are  the  successful  means  of  their  improvement, 
which  is  especially  apparent  in  the  second  class  named. 

Too  much  must  not  be  expected  of  any  form  of  train- 
ing for  the  mentally  defective. 

No  system  can  make  brains;  the  improvement  will  be 
apparent  only  upon  the  limited  amount  that  are  found  at 
hand. 


INDEX 


Accident  in  the  Schoolroom,  179- 

185 

Accommodation,  72 
Adenoids,  86,  87,  93 
Age  for  entering  school,  154 
Air,  19-21 

Alcohol,  evil  effects  of,  164,  165 
Allport,  Dr.  Frank,  on  eye  and 
ear  testing,  76 
Anaemia,  152 
Astigmatism,  74,  77 
Athletics,  169 
Audiometer,  invention  of,  84 

Backward  children,  treatment  of, 
190,  191 

Barr,  Dr.  Martin  W.,  194,  195 
Bathing,  124 
Bathrooms,  8-9 
Bell,  Prof.  A.  Melville,  quoted, 

93 

Bell,  Dr.  A.  N.,  18 
Biggs,  Prof.  Herman  M.,  122 
Blindness,  color,  77 
Bowditch,      Dr.,       Observation 
Table  compiled  by,  56 
Briggs,  Richard,  22 
Brown-Sequard,  20 
Burns,  treatment  of,  182 

Calisthenics,  167 
Cellar,  construction  of,  5 
Chicken  pox,  101,  103,  108 


Cloakrooms,  6 

Cohn,  Dr.,  on  short  sightedness, 
65,  66,  77 

on   types  of   school- 
books,  79,  80 
Conrad,  Dr.,  65 

Committee  of  Fifty,   report  of, 

165 

Consumption,  112,  113 
Corporal  punishment,  172-178 
Corridors,  6 
Crippled  children,  care  of,  54 

Deafness,  causes  of,  82 
Defective  children,  190-195 
Diet,  161-166 
Diphtheria,  99,  101,  no 
Diseases,  contagious,  98-129 

"  school,"  108 

Disinfection,    methods    of,    120, 
121 

Drinking  cups,  117 
Drowning,  184,  185 
Durgin,  Dr.  Samuel  H.,  136,  137 


Ear,  hygiene  of,  82-89 

Ely,  Dr.,  scientific  researches  of, 

65 

Emmetropia,  74 
Entrances,  6 
Epidemics,  100,  120 
Erysipelas,  99 


197 


198 


Index. 


Examinations,  completive,  aboli- 
tion of,  158,  159 
Exercise,  167-171 
Eye,  hygiene  of  the,  64-81 

Fainting,  180 
Farner,  Dr.,  theory  of,  37 
Fevers,  eruptive,  103 
Fire  protection,  13-16 
Fumigation,  8,  120 
Furniture,  school,  35-56 

Gutzman,  Dr.  H.,  92 
Gymnastics,  12 

Hartwell,  Dr.,  93 
Heating,  30-34 

Holmes,     Dr.     Oliver    Wendell, 
quoted,  19 
Hypermetropia,  74 
Hysteria,  153,  181 

Indigestion,  152 
Infantile  paralysis,  125 
Influenza,  99 
Insomnia,  152 

Jenner,  Edward,  103 
Johnson,  Dr.  James,  18 

Kellogg,  Dr.  J.  H.,  quoted,  149- 
I5i 
Klebs-Loeffler  bacilli,  140 


Latrine  system,  n 
Light,  57-63 

Lincoln,  Dr.  D.  F.,  41,  43 
Loring,  Dr.,  65 


MacKenzie,  Sir  Morrell,  quoted, 

95 

Mann,  Horace,  quoted,  175,  176 

Massachusetts     Law     regarding 

school  construction,  13-16 

Massachusetts     Law    regarding 

heating,  34 

Measles,  99,  101,  103,  108 
Medical    inspection    of    schools, 
130-144 

Mitchell,   Dr.   S.   Weir,  quoted, 
146,  147 

Modern   education   and    health, 
145-160 

Moore,    Dr.   John  Jay,   quoted, 
48-50 

Morrison,   Gilbert   B.,   26,  foot- 
note 
Mowry,  Dr.  WT.  A.,  quoted,  62, 

63 

Mumps,  99,  113 
Myopia,  74 

Nervousness,  153 
Nosebleed,  182 

Odors,  27 
Overwork,  146 


Paget,  Charles,  154 
Parkes,  Dr.  Louis  C.     Table  of 
communicable  diseases,  99,  100 
Peck,    Governor    of    Wisconsin, 
quoted,  28,  29 
Pershing,  Dr.,  94 
Photometer,  62 

Physical   training  and   exercise, 
167-171 


Index. 


199 


Playground,  3 
Plumbing,  10-12 
Potter,  Dr.  W.  W.,  quoted,  147, 
148 
Prisms,  62 

Recess,  28,  29,  160 
Reynolds,  Dr.,  136* 
Ringworm,  114,  115 
Robson,  English  authority,  cited, 
53,61 
Rollin,  French  historian,  quoted, 

173-175 
Roof-gardens,  6 

St.  Vitus  Dance,  152,  153 
Scarlet  fever,  99,  101,  103,   109   | 
Schamberg,  Jay  F.,    105 
School  buildings,  construction  of, 
4-16 

hours,  length  of,  154-156 
Schoolyard,  laying  out  of,  3 
Scudd«r,  Dr.  Chas.  L.,  45 
Seguin,  190 
Sickness  in  the  schoolroom,  179- 

185 

Site,  1-3 

Slate  and  pencil,  79,  119 
Sleep,  average  amount  of,  160 
Smallpox,  99,  101-107 
Snellen  test  types,  75 
Speech,  defects  of,  90-97 


Squint  (strabismus),  70 
Stairs,  construction  of,  6 
Stammering,  92 
Study,  home,  157* 
Stuttering,  92 
Sunstroke,  181 
Swimming  tank,  9 
Sylvester's  treatment  of  asphyxia 
from  drowning,  184,  185 

Teacher's  Health,  the,  186-189 
Temperature,  30,  3 1 ,  34 
Tuberculosis,  99,  112,  113 
Types  of  School  Books,  79,  80 
Typhoid  fever,  99,  113,  114 
Typhus  fever,  99,  114 

Vaccination,  compulsory,   103 
Ventilation,  17-29 
Vocal  organs,  90-97 

Walls,  color  of,  63 
Water-closets,  9-12 
Wardrobes,  6-8 
Welch,  Dr.  W.  M.,  105 
Wernher,  Prof.,  103 
Whooping-cough,  99,  ill,  112 
Woodbridge,  Prof.  S.  H.,  18,  19 
Work,  pupil's  capacity  for,   156, 
157 

Young,  Dr.  Meredith,  102 


UNIVERSITY  OF  CALIFORNIA  LIBRARY 


THIS  BOOK  IS  DUE  ON  THE  LAST  DATE 
STAMPED  BELOW 

^ 


MAR  22 

NOM    8 
APR   7  1917 


JUL  121918 
MAR  11 


JUN  16 


NOV 


192h 
/161S27 

0   l«27 


FEB 


1930 


YB'0532! 


254591 


